Provider Demographics
NPI:1780886846
Name:SIAS, CAROLINE MARY (LMP)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:MARY
Last Name:SIAS
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 1:21503 84TH AVE. S.W.
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6713
Mailing Address - Country:US
Mailing Address - Phone:206-463-1510
Mailing Address - Fax:
Practice Address - Street 1:21503 84TH AVE SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6713
Practice Address - Country:US
Practice Address - Phone:206-463-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020068225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist