Provider Demographics
NPI:1861758815
Name:WINTER, MEGAN ASHLEY (LMP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ASHLEY
Last Name:WINTER
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:PO BOX 8101
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-0892
Mailing Address - Country:US
Mailing Address - Phone:360-829-5268
Mailing Address - Fax:
Practice Address - Street 1:423 LONG STREET
Practice Address - Street 2:
Practice Address - City:WILKESON
Practice Address - State:WA
Practice Address - Zip Code:98396
Practice Address - Country:US
Practice Address - Phone:360-829-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60275861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist