Healthcare Provider Details

I. General information

NPI: 1073478376
Provider Name (Legal Business Name): MADILYN JEAN MEYERS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SW CASCADE AVE STE 40F
STEVENSON WA
98648-6284
US

IV. Provider business mailing address

PO BOX 448
CARSON WA
98610-0448
US

V. Phone/Fax

Practice location:
  • Phone: 509-416-6191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29443
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: