Provider Demographics
NPI:1396381653
Name:MEGHAN DEVONPORT, LMP
Entity Type:Organization
Organization Name:MEGHAN DEVONPORT, LMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST/BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVONPORT
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:561-843-5935
Mailing Address - Street 1:3318 159TH LN SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-1545
Mailing Address - Country:US
Mailing Address - Phone:561-843-5935
Mailing Address - Fax:
Practice Address - Street 1:1417 NW 54TH ST STE 455
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3564
Practice Address - Country:US
Practice Address - Phone:561-843-5935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1962651976Medicaid