Provider Demographics
NPI:1265023329
Name:LAWSON, KATHERYN AMANDA (LMT)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:AMANDA
Last Name:LAWSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:AMANDA
Other - Last Name:BATEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:9061 MILLER RD STE 7
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1112
Mailing Address - Country:US
Mailing Address - Phone:810-605-5475
Mailing Address - Fax:
Practice Address - Street 1:9061 MILLER RD STE 7
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1112
Practice Address - Country:US
Practice Address - Phone:810-605-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist