Provider Demographics
NPI:1124350947
Name:SKARBO, TRAISA MALENA (LMP)
Entity type:Individual
Prefix:
First Name:TRAISA
Middle Name:MALENA
Last Name:SKARBO
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 1:9700 ROOSEVELT WAY NE
Mailing Address - Street 2:#305
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2251
Mailing Address - Country:US
Mailing Address - Phone:206-788-7332
Mailing Address - Fax:
Practice Address - Street 1:9700 ROOSEVELT WAY NE
Practice Address - Street 2:#305
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2251
Practice Address - Country:US
Practice Address - Phone:206-788-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00014105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist