Provider Demographics
NPI:1316406275
Name:MEADER, KARA MICHELLE (CDPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MICHELLE
Last Name:MEADER
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 WHITMAN AVE N APT 41
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8791
Mailing Address - Country:US
Mailing Address - Phone:704-299-1642
Mailing Address - Fax:
Practice Address - Street 1:9045 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2355
Practice Address - Country:US
Practice Address - Phone:206-762-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60924595390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program