Provider Demographics
NPI:1427499987
Name:SPRAGUE, AMY PATRICIA (LMP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:PATRICIA
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:PATRICIA
Other - Last Name:BOURGEOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:823 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2347
Mailing Address - Country:US
Mailing Address - Phone:509-839-5555
Mailing Address - Fax:509-839-9875
Practice Address - Street 1:823 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2347
Practice Address - Country:US
Practice Address - Phone:509-839-5555
Practice Address - Fax:509-839-9875
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60043806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist