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General NPI Number Information
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NPI Number | 1245417948
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Entity Type | Individual
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Provider Name | MICHELLE LYN MADDRELL L.AC AND OTL
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Gender | Female
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 8507 NE 8TH WAY
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City | VANCOUVER
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State | WA
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Zip | 98664-1980
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Country | US
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Telephone | 360-254-5335
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 SE 170TH CT
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City | VANCOUVER
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State | WA
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Zip | 98683-8800
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Country | US
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Telephone | 360-852-8148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 3061
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3007
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License Number State | WA
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