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General NPI Number Information
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NPI Number | 1467702274
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Entity Type | Individual
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Provider Name | MOLLY LYN SPRAGUE MA60042872
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 5501 NE 109TH CT STE L
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City | VANCOUVER
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State | WA
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Zip | 98662
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Country | US
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Telephone | 541-905-9112
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Fax |
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Provider Business Mailing Address
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Address Line | 9803 NE 59TH ST
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City | VANCOUVER
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State | WA
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Zip | 98662
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Country | US
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Telephone | 541-905-9112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA60042872
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License Number State | WA
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