Provider Demographics
NPI:1497113732
Name:SPANGLER, MARYN AMARA (LMP)
Entity Type:Individual
Prefix:MISS
First Name:MARYN
Middle Name:AMARA
Last Name:SPANGLER
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 1:4440 190TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9707
Mailing Address - Country:US
Mailing Address - Phone:425-802-7876
Mailing Address - Fax:
Practice Address - Street 1:1151 NW SAMMAMISH RD STE 101
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8937
Practice Address - Country:US
Practice Address - Phone:425-369-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60618373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist