Provider Demographics
NPI:1164015129
Name:CARLTON, KAILEY ANN (LMT)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:ANN
Last Name:CARLTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17430 79TH DR NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-9826
Mailing Address - Country:US
Mailing Address - Phone:425-343-9686
Mailing Address - Fax:
Practice Address - Street 1:17430 79TH DR NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-9826
Practice Address - Country:US
Practice Address - Phone:425-343-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61167848OtherMASSAGE LICENSE NUMBER