Provider Demographics
NPI:1619338613
Name:SPOLTMAN, SHERRI (MPL)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:SPOLTMAN
Suffix:
Gender:F
Credentials:MPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7814
Mailing Address - Country:US
Mailing Address - Phone:360-679-6559
Mailing Address - Fax:
Practice Address - Street 1:421 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-7814
Practice Address - Country:US
Practice Address - Phone:360-679-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011749225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist