Provider Demographics
NPI:1437550183
Name:DURALL, MARCIE LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:LYNN
Last Name:DURALL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:LYNN
Other - Last Name:DURALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NBCOT
Mailing Address - Street 1:8609 82ND ST SW
Mailing Address - Street 2:APT 202
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-7242
Mailing Address - Country:US
Mailing Address - Phone:845-797-7081
Mailing Address - Fax:
Practice Address - Street 1:8609 82ND ST SW
Practice Address - Street 2:APT 202
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-7242
Practice Address - Country:US
Practice Address - Phone:845-797-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60336894174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator