Provider Demographics
NPI:1821401910
Name:MARGESON, MARY JOSEPHINE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOSEPHINE
Last Name:MARGESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY JO
Other - Middle Name:
Other - Last Name:MARGESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:223 140TH ST S
Mailing Address - Street 2:STE 700
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4531
Mailing Address - Country:US
Mailing Address - Phone:253-531-5645
Mailing Address - Fax:253-536-3467
Practice Address - Street 1:223 140TH ST S
Practice Address - Street 2:STE 700
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4531
Practice Address - Country:US
Practice Address - Phone:253-531-5645
Practice Address - Fax:253-536-3467
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60109711225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1821401910Medicaid