Provider Demographics
NPI:1104545441
Name:WILCOX, MEGHAN FAYE (LMT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:FAYE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:FAYE
Other - Last Name:BOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:431 NW 100TH PL APT 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4951
Mailing Address - Country:US
Mailing Address - Phone:210-602-5264
Mailing Address - Fax:
Practice Address - Street 1:10021 HOLMAN RD NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4920
Practice Address - Country:US
Practice Address - Phone:206-829-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61339872225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist