Provider Demographics
NPI:1134441868
Name:FOWLER, MICHELE THERESE (LAC, LMP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:THERESE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 4TH AVE S
Mailing Address - Street 2:STE C
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3515
Mailing Address - Country:US
Mailing Address - Phone:425-778-2838
Mailing Address - Fax:425-640-7423
Practice Address - Street 1:115 4TH AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3515
Practice Address - Country:US
Practice Address - Phone:425-778-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60136223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist