Provider Demographics
NPI:1104943075
Name:GRAHAM, MAUREEN M (LMP)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:M
Other - Last Name:SEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:9669 BRIDGEPORT WAY SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2803
Mailing Address - Country:US
Mailing Address - Phone:253-238-3990
Mailing Address - Fax:253-238-1733
Practice Address - Street 1:9669 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2803
Practice Address - Country:US
Practice Address - Phone:253-238-3990
Practice Address - Fax:253-238-1733
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013322225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist