Provider Demographics
NPI:1629273750
Name:THOMSON, TALITHA JOY (LMP)
Entity Type:Individual
Prefix:MS
First Name:TALITHA
Middle Name:JOY
Last Name:THOMSON
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 1:10357 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-5303
Mailing Address - Country:US
Mailing Address - Phone:206-779-6255
Mailing Address - Fax:
Practice Address - Street 1:4033 STONE WAY NORTH
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8011
Practice Address - Country:US
Practice Address - Phone:206-675-1740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA562402225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist