Healthcare Provider Details

I. General information

NPI: 1861645996
Provider Name (Legal Business Name): CLAYTON DELANEY FARMER ATC, LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12609 NE 132ND ST UNIT B
KIRKLAND WA
98034-3139
US

IV. Provider business mailing address

12609 NE 132ND ST UNIT B
KIRKLAND WA
98034-3139
US

V. Phone/Fax

Practice location:
  • Phone: 425-516-9919
  • Fax:
Mailing address:
  • Phone: 425-516-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA160047875
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00011153
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: