Provider Demographics
NPI:1477879013
Name:KISPERT, MARCY (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:
Last Name:KISPERT
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:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:SUQUAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98392-1357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20270 FRONT ST NE
Practice Address - Street 2:SUITE 202
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7356
Practice Address - Country:US
Practice Address - Phone:360-265-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020574225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist