Healthcare Provider Details

I. General information

NPI: 1730222092
Provider Name (Legal Business Name): MARIE ELAINE SNYDER-AYALA LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11314 4TH AVE W STE 103
EVERETT WA
98204-6926
US

IV. Provider business mailing address

5720 60TH DR NE
MARYSVILLE WA
98270-9522
US

V. Phone/Fax

Practice location:
  • Phone: 425-355-3739
  • Fax: 425-514-8353
Mailing address:
  • Phone: 425-244-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00014783
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: