Provider Demographics
NPI:1740983345
Name:SPILLMAN, JESSICA ALYSSA (LMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALYSSA
Last Name:SPILLMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N WIGEON PL
Mailing Address - Street 2:
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548-9527
Mailing Address - Country:US
Mailing Address - Phone:775-360-0730
Mailing Address - Fax:
Practice Address - Street 1:LAKE CUSHMAN
Practice Address - Street 2:
Practice Address - City:HOODSPORT
Practice Address - State:WA
Practice Address - Zip Code:98548-9854
Practice Address - Country:US
Practice Address - Phone:775-360-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61233520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist