Provider Demographics
NPI:1407021264
Name:SNIFFEN, MELODY (LMP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:SNIFFEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:215 S G ST
Mailing Address - Street 2:#34
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4706
Mailing Address - Country:US
Mailing Address - Phone:253-720-0315
Mailing Address - Fax:
Practice Address - Street 1:33400 13TH PL S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6357
Practice Address - Country:US
Practice Address - Phone:255-383-8607
Practice Address - Fax:253-838-6069
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023313225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist