Provider Demographics
NPI:1346457587
Name:DEVAULT, CAREY JAN (LMP)
Entity Type:Individual
Prefix:MS
First Name:CAREY
Middle Name:JAN
Last Name:DEVAULT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PMB 163
Mailing Address - Street 2:6619 132ND AVE NE
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-882-9065
Mailing Address - Fax:425-558-1900
Practice Address - Street 1:8301 161ST AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-882-9065
Practice Address - Fax:425-558-1900
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist