Provider Demographics
NPI:1215756713
Name:MEADOWS, JAMIE ERLENE (LMT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ERLENE
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16785 N STATE ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:MEADOW BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25976-8804
Mailing Address - Country:US
Mailing Address - Phone:304-887-6159
Mailing Address - Fax:
Practice Address - Street 1:3136 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3723
Practice Address - Country:US
Practice Address - Phone:304-890-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2021-3855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty