Provider Demographics
NPI:1689800187
Name:MACDONALD, BLAIR LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:LYNN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:LYNN
Other - Last Name:CRITTENDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 3033
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3033
Mailing Address - Country:US
Mailing Address - Phone:360-739-0411
Mailing Address - Fax:360-692-3469
Practice Address - Street 1:11871 SILVERDALE WAY NW
Practice Address - Street 2:SUITE 103
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9414
Practice Address - Country:US
Practice Address - Phone:360-739-0411
Practice Address - Fax:360-692-3469
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00021185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist