Provider Demographics
NPI:1902958556
Name:RANDALL, CLAUDIA J (LMP)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:J
Last Name:RANDALL
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 1:18906 NUTMEG ST. SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579
Mailing Address - Country:US
Mailing Address - Phone:360-858-7483
Mailing Address - Fax:360-858-7483
Practice Address - Street 1:18906 NUTMEG ST. SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579
Practice Address - Country:US
Practice Address - Phone:360-858-7483
Practice Address - Fax:360-858-7483
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9074174400000X
WAMA000090754225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA107553OtherWORKERS COMPENSATION
WA107553OtherLABOR AND INDUSTRIES
WA384265100000OtherPREMERA