Provider Demographics
NPI:1235344300
Name:CAMPBELL, SHARON KAY (LMP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAY
Last Name:CAMPBELL
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 1:1715 223RD PL NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4154
Mailing Address - Country:US
Mailing Address - Phone:425-457-2898
Mailing Address - Fax:425-868-8928
Practice Address - Street 1:1715 223RD PL NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-4154
Practice Address - Country:US
Practice Address - Phone:425-457-2898
Practice Address - Fax:425-868-8928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00007659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist