Provider Demographics
NPI:1720386410
Name:SMITH, MARCI AILEEN (LMT)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:AILEEN
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 1:30741 3RD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-9791
Mailing Address - Country:US
Mailing Address - Phone:360-886-9955
Mailing Address - Fax:
Practice Address - Street 1:30741 3RD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BLACK DIAMOND
Practice Address - State:WA
Practice Address - Zip Code:98010-9791
Practice Address - Country:US
Practice Address - Phone:360-886-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005208225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist