Provider Demographics
NPI:1568838175
Name:LINDQUIST, KAITLIN JANE MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:JANE MARIE
Last Name:LINDQUIST
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 1:2804 GRAND AVE
Mailing Address - Street 2:#307
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3430
Mailing Address - Country:US
Mailing Address - Phone:206-557-2864
Mailing Address - Fax:
Practice Address - Street 1:2804 GRAND AVE
Practice Address - Street 2:#307
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3430
Practice Address - Country:US
Practice Address - Phone:206-557-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60580724225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist