Healthcare Provider Details

I. General information

NPI: 1245702984
Provider Name (Legal Business Name): MARYSSA SCARCELLO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 E MAYFLOWER LN STE 6
WASILLA AK
99654
US

IV. Provider business mailing address

5461 E MAYFLOWER LN STE 6
WASILLA AK
99654-7892
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-6688
  • Fax:
Mailing address:
  • Phone: 907-357-6688
  • Fax: 907-357-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number138854
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: