Provider Demographics
NPI:1205332855
Name:CONDIE, CAMILLE (MA60845640)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:CONDIE
Suffix:
Gender:F
Credentials:MA60845640
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 35TH PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-6999
Mailing Address - Country:US
Mailing Address - Phone:801-558-4174
Mailing Address - Fax:
Practice Address - Street 1:20833 67TH AVE W STE 301
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7365
Practice Address - Country:US
Practice Address - Phone:425-697-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist