Provider Demographics
NPI:1609110709
Name:CASELLO, CELESTE A (LMP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:A
Last Name:CASELLO
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 1:21650 14TH AVE S APT F2
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:636 SW 152ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2264
Practice Address - Country:US
Practice Address - Phone:206-226-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0000937225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist