Provider Demographics
NPI:1558682161
Name:DONAHUE, CAITLIN ANNE (LMP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ANNE
Last Name:DONAHUE
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 1:1 N STADIUM WAY
Mailing Address - Street 2:#2
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3119
Mailing Address - Country:US
Mailing Address - Phone:253-414-5335
Mailing Address - Fax:
Practice Address - Street 1:1720 S 72ND ST
Practice Address - Street 2:STE. 201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1245
Practice Address - Country:US
Practice Address - Phone:253-471-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60142096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist