Provider Demographics
NPI:1558488346
Name:MCMAHAN, TAMMY (LMP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 109TH PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5438
Mailing Address - Country:US
Mailing Address - Phone:425-330-1733
Mailing Address - Fax:425-316-9288
Practice Address - Street 1:7207 EVERGREEN WAY STE N
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-5678
Practice Address - Country:US
Practice Address - Phone:425-330-1733
Practice Address - Fax:425-316-9288
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist