Provider Demographics
NPI:1003197013
Name:BAKER, KATHARINE MICHELA (LMP)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:MICHELA
Last Name:BAKER
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 1:3616 GREENWOOD AVE N
Mailing Address - Street 2:APT 3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8526
Mailing Address - Country:US
Mailing Address - Phone:503-481-2939
Mailing Address - Fax:
Practice Address - Street 1:15650 NE 24TH ST
Practice Address - Street 2:SUITE C2
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2460
Practice Address - Country:US
Practice Address - Phone:503-481-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60225627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist