Provider Demographics
NPI:1215794847
Name:SCOVEL, CHERRISH (MA00024844)
Entity type:Individual
Prefix:
First Name:CHERRISH
Middle Name:
Last Name:SCOVEL
Suffix:
Gender:F
Credentials:MA00024844
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 IRVING ST SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6361
Mailing Address - Country:US
Mailing Address - Phone:253-590-3234
Mailing Address - Fax:
Practice Address - Street 1:2415 EVERGREEN PARK DR SW STE C3
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6007
Practice Address - Country:US
Practice Address - Phone:253-590-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist