Provider Demographics
NPI:1982930129
Name:BROWN, CAITLIN MERCEDES (LMP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MERCEDES
Last Name:BROWN
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 1:1221 SW 126TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3075
Mailing Address - Country:US
Mailing Address - Phone:360-280-0267
Mailing Address - Fax:206-707-9907
Practice Address - Street 1:15210 10TH AVE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2107
Practice Address - Country:US
Practice Address - Phone:206-299-2654
Practice Address - Fax:206-707-9907
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60117089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist