Provider Demographics
NPI:1326581885
Name:SMITH, MEGEN (LMT)
Entity Type:Individual
Prefix:
First Name:MEGEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15021 MAIN ST STE K
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1651
Mailing Address - Country:US
Mailing Address - Phone:425-948-7856
Mailing Address - Fax:425-948-6806
Practice Address - Street 1:15021 MAIN ST STE K
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1651
Practice Address - Country:US
Practice Address - Phone:425-948-7856
Practice Address - Fax:425-948-6806
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60678917225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist