Provider Demographics
NPI:1356419907
Name:ALTER, SHAILA MAE (LMT)
Entity type:Individual
Prefix:MS
First Name:SHAILA
Middle Name:MAE
Last Name:ALTER
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:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-0513
Mailing Address - Country:US
Mailing Address - Phone:503-319-5349
Mailing Address - Fax:503-668-7084
Practice Address - Street 1:11516 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5005
Practice Address - Country:US
Practice Address - Phone:360-253-6674
Practice Address - Fax:360-253-8670
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021952174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist