Provider Demographics
NPI:1457407728
Name:PICTON, TODD ODELL (LMP, CNMT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ODELL
Last Name:PICTON
Suffix:
Gender:M
Credentials:LMP, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8748 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3034
Mailing Address - Country:US
Mailing Address - Phone:206-632-5596
Mailing Address - Fax:
Practice Address - Street 1:1737 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5229
Practice Address - Country:US
Practice Address - Phone:206-525-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist