Provider Demographics
NPI:1629850037
Name:SPRAGUE, TAYLOR CHRISTINE (MA61496549)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHRISTINE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MA61496549
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9830 W 31ST PL
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9287
Mailing Address - Country:US
Mailing Address - Phone:360-366-6462
Mailing Address - Fax:
Practice Address - Street 1:2410 YEW ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-3940
Practice Address - Country:US
Practice Address - Phone:360-733-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61496549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty