Healthcare Provider Details

I. General information

NPI: 1306093729
Provider Name (Legal Business Name): ALISON M SPRADA LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17528 MERIDIAN E STE 207
PUYALLUP WA
98375-6286
US

IV. Provider business mailing address

17528 MERIDIAN E STE 207
PUYALLUP WA
98375-6286
US

V. Phone/Fax

Practice location:
  • Phone: 253-445-9030
  • Fax:
Mailing address:
  • Phone: 253-445-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA000I4954
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: