Provider Demographics
NPI:1376893446
Name:WILSEY, CASEY (LMT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:WILSEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S 2ND ST STE 714
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2629
Mailing Address - Country:US
Mailing Address - Phone:509-424-3420
Mailing Address - Fax:509-424-3420
Practice Address - Street 1:6 S 2ND ST STE 714
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2629
Practice Address - Country:US
Practice Address - Phone:509-424-3420
Practice Address - Fax:509-424-3420
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60302889225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist