Provider Demographics
NPI:1215120886
Name:COUGHLIN, LORI JO (LMP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:JO
Last Name:COUGHLIN
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 1:826 N MULLAN RD
Mailing Address - Street 2:STE B
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4094
Mailing Address - Country:US
Mailing Address - Phone:509-928-8550
Mailing Address - Fax:509-928-8592
Practice Address - Street 1:826 N MULLAN RD
Practice Address - Street 2:STE B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4094
Practice Address - Country:US
Practice Address - Phone:509-928-8550
Practice Address - Fax:509-928-8592
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022191225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist