Provider Demographics
NPI:1134278377
Name:WAITE, KATHRYN L (LMP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:WAITE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:L
Other - Last Name:WAITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:732 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:US
Mailing Address - Phone:360-834-3434
Mailing Address - Fax:
Practice Address - Street 1:732 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607
Practice Address - Country:US
Practice Address - Phone:360-834-3434
Practice Address - Fax:360-834-2637
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist