Provider Demographics
NPI:1295041150
Name:CASAD, JODI JANETTE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:JANETTE
Last Name:CASAD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:JODI
Other - Middle Name:JANETTE
Other - Last Name:WETMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:18503 SE 330TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-9112
Mailing Address - Country:US
Mailing Address - Phone:253-632-4910
Mailing Address - Fax:
Practice Address - Street 1:17407 SE WAX RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-9126
Practice Address - Country:US
Practice Address - Phone:253-630-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009204225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist