Provider Demographics
NPI:1184128316
Name:DROUYOR, MARISSA RAEANN GONZALEZ (MA)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:RAEANN GONZALEZ
Last Name:DROUYOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:RAEANN
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:4625 45TH AVE SE APT E12
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5507
Mailing Address - Country:US
Mailing Address - Phone:360-463-2722
Mailing Address - Fax:
Practice Address - Street 1:5401 CORPORATE CENTER LOOP SE STE K11
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5606
Practice Address - Country:US
Practice Address - Phone:360-918-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60811369225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist