Provider Demographics
NPI:1386984995
Name:WINTERS, MEGAN JOEANNE (LMP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JOEANNE
Last Name:WINTERS
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:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:ORONDO
Mailing Address - State:WA
Mailing Address - Zip Code:98843-0252
Mailing Address - Country:US
Mailing Address - Phone:509-860-5904
Mailing Address - Fax:
Practice Address - Street 1:1201 DESERT CANYON BLVD
Practice Address - Street 2:
Practice Address - City:ORONDO
Practice Address - State:WA
Practice Address - Zip Code:98843-9630
Practice Address - Country:US
Practice Address - Phone:509-860-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60275441225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist