Healthcare Provider Details

I. General information

NPI: 1316072614
Provider Name (Legal Business Name): PATRICIA A MEYER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19410 8TH AVE NE SUITE 101
POULSBO WA
98370-7379
US

IV. Provider business mailing address

PO BOX 1006
KINGSTON WA
98346-1006
US

V. Phone/Fax

Practice location:
  • Phone: 425-829-8440
  • Fax:
Mailing address:
  • Phone: 425-829-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00007414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: