Provider Demographics
NPI:1346341856
Name:WATSON, PAIGE CLYDE (LMP)
Entity Type:Individual
Prefix:MR
First Name:PAIGE
Middle Name:CLYDE
Last Name:WATSON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MAIN ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6108
Mailing Address - Country:US
Mailing Address - Phone:425-829-5771
Mailing Address - Fax:
Practice Address - Street 1:218 MAIN ST # 315
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6108
Practice Address - Country:US
Practice Address - Phone:425-829-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020455225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist