Individual
CARLY SPROUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MP
Contact information
Practice address
811 11TH AVE, LONGVIEW, WA 98632-2462
(503) 338-8826
Mailing address
41108 HILLCREST LOOP, ASTORIA, OR 97103-8646
(503) 338-8826
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
06/01/2018
Last updated
06/01/2018
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