Provider Demographics
NPI:1053853085
Name:PATTILLO, PAIGE LINDER (LMP)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:LINDER
Last Name:PATTILLO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21715 49TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8042
Mailing Address - Country:US
Mailing Address - Phone:206-818-5611
Mailing Address - Fax:
Practice Address - Street 1:21715 49TH AVE SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8042
Practice Address - Country:US
Practice Address - Phone:206-818-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60580744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist