Provider Demographics
NPI:1326717984
Name:MILLER, KATIE LEBLANC (LMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LEBLANC
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 TREASURE LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5116
Mailing Address - Country:US
Mailing Address - Phone:406-871-8609
Mailing Address - Fax:
Practice Address - Street 1:22 2ND AVE W STE 1300
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4480
Practice Address - Country:US
Practice Address - Phone:406-871-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist