Provider Demographics
NPI:1457526246
Name:ADAMS, FAWN C (LMP)
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:C
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:C
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4707 E UPRIVER DR APT K102
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-7387
Mailing Address - Country:US
Mailing Address - Phone:509-435-7467
Mailing Address - Fax:
Practice Address - Street 1:13701 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0811
Practice Address - Country:US
Practice Address - Phone:509-922-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00025015225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist