Provider Demographics
NPI:1720402670
Name:MAYOTTE, CAITLIN (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:MAYOTTE
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15003 75TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4649
Mailing Address - Country:US
Mailing Address - Phone:734-646-6884
Mailing Address - Fax:
Practice Address - Street 1:15003 75TH AVE NE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4649
Practice Address - Country:US
Practice Address - Phone:734-646-6884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60440491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist