Provider Demographics
NPI:1427116912
Name:BEAUVAIS, MADELINE ALICE (LMP)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:ALICE
Last Name:BEAUVAIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0175
Mailing Address - Country:US
Mailing Address - Phone:360-608-4370
Mailing Address - Fax:541-526-5110
Practice Address - Street 1:8515 NE HAZEL DELL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8144
Practice Address - Country:US
Practice Address - Phone:360-608-4370
Practice Address - Fax:541-526-5110
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist