Healthcare Provider Details

I. General information

NPI: 1336424092
Provider Name (Legal Business Name): CHRISTINE MICHELE CAPLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

IV. Provider business mailing address

501 WAUNCH ST
CENTRALIA WA
98531-3353
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP1 60045652
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 60253261
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: