Provider Demographics
NPI:1427299478
Name:FITCH, MARY ANN (LMP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:FITCH
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 1:314 E QUEEN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1363
Mailing Address - Country:US
Mailing Address - Phone:509-487-1930
Mailing Address - Fax:
Practice Address - Street 1:2911 W NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2378
Practice Address - Country:US
Practice Address - Phone:509-326-6669
Practice Address - Fax:509-326-6669
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60007104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist