Provider Demographics
NPI:1992505937
Name:STOVALL, CHARENE ESHAUN (LMT)
Entity type:Individual
Prefix:
First Name:CHARENE
Middle Name:ESHAUN
Last Name:STOVALL
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19023 SE 266TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8470
Mailing Address - Country:US
Mailing Address - Phone:360-561-3241
Mailing Address - Fax:
Practice Address - Street 1:728 S 320TH ST STE G
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5255
Practice Address - Country:US
Practice Address - Phone:206-212-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61662544225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist