Provider Demographics
NPI:1578920807
Name:VAIL, ALISON ANGELA (MA00013891)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:ANGELA
Last Name:VAIL
Suffix:
Gender:F
Credentials:MA00013891
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13516 61ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9402
Mailing Address - Country:US
Mailing Address - Phone:206-226-7107
Mailing Address - Fax:
Practice Address - Street 1:13516 61ST AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9402
Practice Address - Country:US
Practice Address - Phone:206-226-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013891225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist