Provider Demographics
NPI:1306098892
Name:MAIER, THEODORE THOMAS (LMP)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:THOMAS
Last Name:MAIER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 NE 90TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9157
Mailing Address - Country:US
Mailing Address - Phone:503-577-7839
Mailing Address - Fax:
Practice Address - Street 1:210 E MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3369
Practice Address - Country:US
Practice Address - Phone:360-718-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60022321174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0241664OtherLABOR AND INDUSTRIES