Provider Demographics
NPI:1801969787
Name:FOSTER, MAKAIA MARGARET (LM; LMT)
Entity type:Individual
Prefix:MS
First Name:MAKAIA
Middle Name:MARGARET
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LM; LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 W. HAYDEN AV.
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835
Mailing Address - Country:US
Mailing Address - Phone:208-819-0929
Mailing Address - Fax:208-762-6773
Practice Address - Street 1:2151 W HAYDEN AVE
Practice Address - Street 2:SU 103
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7414
Practice Address - Country:US
Practice Address - Phone:208-819-0929
Practice Address - Fax:208-762-6772
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007833225700000X
WAMW00000118176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8080018004Medicaid