Provider Demographics
NPI:1417241035
Name:SPAKE, MARGUERITE PINGREY (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARGUERITE
Middle Name:PINGREY
Last Name:SPAKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:PEPI
Other - Middle Name:
Other - Last Name:PINGREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1820 SW VERMONT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1945
Mailing Address - Country:US
Mailing Address - Phone:503-320-4913
Mailing Address - Fax:
Practice Address - Street 1:1820 SW VERMONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1945
Practice Address - Country:US
Practice Address - Phone:503-320-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist