Provider Demographics
NPI:1215568712
Name:CALDERON, CAPRESE MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:CAPRESE
Middle Name:MARIE
Last Name:CALDERON
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 1:3131 SMOKEY POINT DR STE 5B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-2301
Mailing Address - Country:US
Mailing Address - Phone:360-653-9600
Mailing Address - Fax:
Practice Address - Street 1:3131 SMOKEY POINT DR STE 5B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-2301
Practice Address - Country:US
Practice Address - Phone:360-653-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60985592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60985592OtherWA DOH MASSAGE THERAPY LICENSE