Provider Demographics
NPI:1336276880
Name:MCGLOTHLIN, CAROLYN SUE (LMP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:SUE
Last Name:MCGLOTHLIN
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 1:1155 N STATE ST
Mailing Address - Street 2:#428
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5037
Mailing Address - Country:US
Mailing Address - Phone:360-738-7022
Mailing Address - Fax:
Practice Address - Street 1:1155 N STATE ST
Practice Address - Street 2:#428
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5037
Practice Address - Country:US
Practice Address - Phone:360-738-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist