Provider Demographics
NPI:1952441545
Name:TUCKER, MEGAN ELISABETH (LMP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ELISABETH
Last Name:TUCKER
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 1:3428 13TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-1611
Mailing Address - Country:US
Mailing Address - Phone:206-409-8466
Mailing Address - Fax:
Practice Address - Street 1:5801 PHINNEY AVE N
Practice Address - Street 2:#100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5862
Practice Address - Country:US
Practice Address - Phone:206-409-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist