Provider Demographics
NPI:1346367141
Name:MAPLES, CAROL J (LMP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:MAPLES
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 1:15110 SE 114TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-6004
Mailing Address - Country:US
Mailing Address - Phone:425-894-6090
Mailing Address - Fax:
Practice Address - Street 1:15935 NE 8TH ST
Practice Address - Street 2:SUITE A104
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3918
Practice Address - Country:US
Practice Address - Phone:425-894-6090
Practice Address - Fax:425-865-9183
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist