Provider Demographics
NPI:1881079515
Name:MCAULEY, KEITH (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:MCAULEY
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16704 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3116
Mailing Address - Country:US
Mailing Address - Phone:206-246-8830
Mailing Address - Fax:206-244-4690
Practice Address - Street 1:6608 LINDEN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5671
Practice Address - Country:US
Practice Address - Phone:206-229-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist