Provider Demographics
NPI:1083155220
Name:VEACH, KATHRYN (LMP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:VEACH
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 1:509 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2161
Mailing Address - Country:US
Mailing Address - Phone:360-726-9610
Mailing Address - Fax:
Practice Address - Street 1:6204 NE HIGHWAY 99 STE C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8746
Practice Address - Country:US
Practice Address - Phone:360-576-1600
Practice Address - Fax:360-693-0078
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60528460225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist