Provider Demographics
NPI:1790269876
Name:MEISCH, JOSEPHINE TENNEY (LMP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:TENNEY
Last Name:MEISCH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:JOSEPHINE
Other - Middle Name:TENNEY
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:32432 137TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SULTAN
Mailing Address - State:WA
Mailing Address - Zip Code:98294-8709
Mailing Address - Country:US
Mailing Address - Phone:801-631-3910
Mailing Address - Fax:
Practice Address - Street 1:16818 140TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9001
Practice Address - Country:US
Practice Address - Phone:801-631-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60428036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist