Provider Demographics
NPI:1861645996
Name:FARMER, CLAYTON DELANEY (ATC, LMP)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:DELANEY
Last Name:FARMER
Suffix:
Gender:M
Credentials:ATC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12609 NE 132ND ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3139
Mailing Address - Country:US
Mailing Address - Phone:425-516-9919
Mailing Address - Fax:
Practice Address - Street 1:12609 NE 132ND ST
Practice Address - Street 2:UNIT B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3139
Practice Address - Country:US
Practice Address - Phone:425-516-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1600478752255A2300X
WAMA00011153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist