Provider Demographics
NPI:1740334051
Name:MARCELLAY, LAURA A (LMP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:MARCELLAY
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 1:501 SE 123RD AVE APT Z189
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4044
Mailing Address - Country:US
Mailing Address - Phone:360-931-8204
Mailing Address - Fax:
Practice Address - Street 1:12014 SE MILL PLAIN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4044
Practice Address - Country:US
Practice Address - Phone:360-931-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019689174400000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist