Provider Demographics
NPI:1518774694
Name:STEAM, MEZZO MYA
Entity type:Individual
Prefix:
First Name:MEZZO
Middle Name:MYA
Last Name:STEAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 STEAMBOAT ISLAND RD NW # 497
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4876
Mailing Address - Country:US
Mailing Address - Phone:626-628-5923
Mailing Address - Fax:
Practice Address - Street 1:6541 SEXTON DR NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-9222
Practice Address - Country:US
Practice Address - Phone:360-866-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025152225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist