Provider Demographics
NPI:1548822968
Name:SMILEY, MEAGAN ILENE (LMP)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ILENE
Last Name:SMILEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16303 HIGHWAY 99 STE 1B
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-1453
Mailing Address - Country:US
Mailing Address - Phone:425-743-9460
Mailing Address - Fax:425-743-9409
Practice Address - Street 1:16303 HIGHWAY 99 STE 1B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-1453
Practice Address - Country:US
Practice Address - Phone:425-743-9460
Practice Address - Fax:425-743-9409
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60980543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist