Provider Demographics
NPI:1043576259
Name:TAMAYO, CASEY-LYNN (CMT)
Entity Type:Individual
Prefix:
First Name:CASEY-LYNN
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 PALMETTO AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2796
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2014 PALMETTO AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2796
Practice Address - Country:US
Practice Address - Phone:650-898-8416
Practice Address - Fax:650-475-1823
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26495225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist