Provider Demographics
NPI:1013313808
Name:LAKIP, MICA
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:
Last Name:LAKIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICA
Other - Middle Name:
Other - Last Name:DEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:805 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1928
Mailing Address - Country:US
Mailing Address - Phone:206-407-4391
Mailing Address - Fax:
Practice Address - Street 1:701 5TH AVE
Practice Address - Street 2:STE 212
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-7097
Practice Address - Country:US
Practice Address - Phone:206-464-4250
Practice Address - Fax:206-829-2051
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60471664225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist