Provider Demographics
NPI:1851788061
Name:MCCLAIRE, COLETTE ELIZABETH (LMP)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:ELIZABETH
Last Name:MCCLAIRE
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 1:13307 164TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1717
Mailing Address - Country:US
Mailing Address - Phone:425-420-2680
Mailing Address - Fax:
Practice Address - Street 1:17401 135TH AVE NE
Practice Address - Street 2:SUITE 1
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6825
Practice Address - Country:US
Practice Address - Phone:425-420-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60394459225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist