Provider Demographics
NPI:1710239322
Name:GASPAROTTI, MARION LESLIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:LESLIE
Last Name:GASPAROTTI
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MILL RD
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-4232
Mailing Address - Country:US
Mailing Address - Phone:208-365-6697
Mailing Address - Fax:
Practice Address - Street 1:900 MILL RD
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-4232
Practice Address - Country:US
Practice Address - Phone:208-365-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID608506-11225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist