Provider Demographics
NPI:1063664399
Name:LAYTON, MICHELLE ANNE (LMP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANNE
Last Name:LAYTON
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 1:16512 62ND PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-2702
Mailing Address - Country:US
Mailing Address - Phone:206-719-1453
Mailing Address - Fax:
Practice Address - Street 1:18920 BOTHELL WAY NE STE 204
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1981
Practice Address - Country:US
Practice Address - Phone:425-424-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60021386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist