Provider Demographics
NPI:1306124235
Name:CLAYPOOL, BLANCA (LMT)
Entity type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:
Last Name:CLAYPOOL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2857
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-2857
Mailing Address - Country:US
Mailing Address - Phone:541-231-1530
Mailing Address - Fax:
Practice Address - Street 1:2027 HILARY LANE
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6377
Practice Address - Country:US
Practice Address - Phone:541-231-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17762225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist