Provider Demographics
NPI:1730656554
Name:SMALLS, MARISSA REBECCA (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:REBECCA
Last Name:SMALLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MISSY
Other - Middle Name:REBECCA
Other - Last Name:SMALLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1201 3RD AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3027
Mailing Address - Country:US
Mailing Address - Phone:206-453-2233
Mailing Address - Fax:
Practice Address - Street 1:1201 3RD AVE STE 180
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3027
Practice Address - Country:US
Practice Address - Phone:206-453-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60896381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist