Healthcare Provider Details

I. General information

NPI: 1245417948
Provider Name (Legal Business Name): MICHELLE LYN MADDRELL L.AC AND OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 NE 8TH WAY
VANCOUVER WA
98664-1980
US

IV. Provider business mailing address

4105 SE 170TH CT
VANCOUVER WA
98683-8800
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-5335
  • Fax:
Mailing address:
  • Phone: 360-852-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3061
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3007
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: