Provider Demographics
NPI:1003628587
Name:SUN, TAYLOR MEADOW (LMT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MEADOW
Last Name:SUN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:W
Other - Last Name:SIMS
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:914 NW IVY ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-1949
Mailing Address - Country:US
Mailing Address - Phone:425-830-5184
Mailing Address - Fax:
Practice Address - Street 1:17030 SE 1ST ST STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8514
Practice Address - Country:US
Practice Address - Phone:360-604-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60075268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist