Provider Demographics
NPI:1326360298
Name:WILLARD, MARY CATHERINE (LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:WILLARD
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 1:14907 W AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9643
Mailing Address - Country:US
Mailing Address - Phone:509-465-4534
Mailing Address - Fax:
Practice Address - Street 1:430 W 2ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-6003
Practice Address - Country:US
Practice Address - Phone:509-863-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60106211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60106211OtherMASSAGE THERAPIST