Provider Demographics
NPI:1609902204
Name:SMITH, SHILOH (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SHILOH
Middle Name:
Last Name:SMITH
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 1:12704 MUKILTEO SPEEDWAY
Mailing Address - Street 2:STE. C
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5720
Mailing Address - Country:US
Mailing Address - Phone:425-290-1919
Mailing Address - Fax:
Practice Address - Street 1:12704 MUKILTEO SPEEDWAY
Practice Address - Street 2:STE. C
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5720
Practice Address - Country:US
Practice Address - Phone:425-290-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021583174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0203404OtherLABOR AND INDUSTRIES