Provider Demographics
NPI:1760667125
Name:GAMOLO, MARICHELLE MERCADO (LMP)
Entity Type:Individual
Prefix:MISS
First Name:MARICHELLE
Middle Name:MERCADO
Last Name:GAMOLO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:MARICHELLE
Other - Middle Name:GAMOLO
Other - Last Name:CERESOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5725 S 294TH PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2106
Mailing Address - Country:US
Mailing Address - Phone:206-779-9096
Mailing Address - Fax:
Practice Address - Street 1:5725 S 294TH PL
Practice Address - Street 2:APT #I204
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2106
Practice Address - Country:US
Practice Address - Phone:206-779-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024991225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist