Provider Demographics
NPI:1457461899
Name:SPORES, MARY E
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SPORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:CLAUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:15436 BEL RED RD
Mailing Address - Street 2:STE 100
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5536
Mailing Address - Country:US
Mailing Address - Phone:425-644-4100
Mailing Address - Fax:425-644-4101
Practice Address - Street 1:15436 BEL RED RD
Practice Address - Street 2:STE 100
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5536
Practice Address - Country:US
Practice Address - Phone:425-644-4100
Practice Address - Fax:425-644-4101
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0202392OtherL&I