=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134441868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE THERESE FOWLER LAC, LMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2010
-----------------------------------------------------
Last Update Date | 05/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 4TH AVE S SUITE B
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98020-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-778-2838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 4TH AVE S STE C
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98020-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-778-2838
-----------------------------------------------------
Fax | 425-640-7423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 60136223
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------