Provider Demographics
NPI:1184009987
Name:FORESTER, KATHRYN (LMP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FORESTER
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 1:19987 1ST AVE S
Mailing Address - Street 2:SUITE #102
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2400
Mailing Address - Country:US
Mailing Address - Phone:206-259-0225
Mailing Address - Fax:
Practice Address - Street 1:19987 1ST AVE S
Practice Address - Street 2:SUITE #102
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2400
Practice Address - Country:US
Practice Address - Phone:206-259-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60503729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist