Provider Demographics
NPI:1194851014
Name:MARCELLE, STEPHANIE RENEE (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:MARCELLE
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 1:10909 PORTLAND AVE E
Mailing Address - Street 2:SUITE F
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-5252
Mailing Address - Country:US
Mailing Address - Phone:253-970-0433
Mailing Address - Fax:253-535-1349
Practice Address - Street 1:10909 PORTLAND AVE E
Practice Address - Street 2:SUITE F
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-5252
Practice Address - Country:US
Practice Address - Phone:253-970-0433
Practice Address - Fax:253-535-1349
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA22058225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA206993OtherWORKERS COMP