Provider Demographics
NPI:1104190164
Name:SPICER, RUTH ALINA (LMP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ALINA
Last Name:SPICER
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 1:8616 NE 239TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-5313
Mailing Address - Country:US
Mailing Address - Phone:360-449-2686
Mailing Address - Fax:
Practice Address - Street 1:8616 NE 239TH ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-5313
Practice Address - Country:US
Practice Address - Phone:360-449-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60269387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist