Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60623545 | WA |
NPI | 1003358441 |
---|---|
Provider Name | Michelle Jean Meadows |
First Address | Washougal, WA 98671 |
Second Address | Portland, OR 97214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2016 |
Last Update Date | 17/11/2016 |