Provider Demographics
NPI:1578066007
Name:SPURGEON-SCRIMPSHER, MARY ELIZABETH (MA60668217)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:SPURGEON-SCRIMPSHER
Suffix:
Gender:F
Credentials:MA60668217
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 S 374TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-8723
Mailing Address - Country:US
Mailing Address - Phone:253-495-8103
Mailing Address - Fax:
Practice Address - Street 1:5631 TACOMA MALL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6901
Practice Address - Country:US
Practice Address - Phone:253-682-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60668217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist