Provider Demographics
NPI:1831376193
Name:MAYHEW, TABITHA MICHELLE (LMP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:MICHELLE
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:MICHELLE
Other - Last Name:FEMLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:12506 16TH ST NE
Mailing Address - Street 2:APT B5
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1519
Practice Address - Country:US
Practice Address - Phone:360-863-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist