Provider Demographics
NPI:1306373105
Name:THOMPSON, CAITLYN (LMP)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:THOMPSON
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 1:9822 49TH DR NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2318
Mailing Address - Country:US
Mailing Address - Phone:425-501-6006
Mailing Address - Fax:
Practice Address - Street 1:3131 SMOKEY POINT DR
Practice Address - Street 2:#5B
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-4711
Practice Address - Country:US
Practice Address - Phone:425-501-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60117644225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist