Provider Demographics
NPI:1730241779
Name:VOSAHLO, MARTHA ANNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ANNE
Last Name:VOSAHLO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2917
Mailing Address - Country:US
Mailing Address - Phone:509-993-1712
Mailing Address - Fax:
Practice Address - Street 1:2721 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3940
Practice Address - Country:US
Practice Address - Phone:509-535-3038
Practice Address - Fax:509-535-9749
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist