Provider Demographics
NPI:1255569869
Name:CICIRELLI, ABBY (LMP)
Entity type:Individual
Prefix:MISS
First Name:ABBY
Middle Name:
Last Name:CICIRELLI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 W CASINO RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2109
Mailing Address - Country:US
Mailing Address - Phone:425-319-9588
Mailing Address - Fax:
Practice Address - Street 1:12326 POSSESSION LN
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-3147
Practice Address - Country:US
Practice Address - Phone:425-319-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA#00004012225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist