Provider Demographics
NPI:1386863983
Name:UNDERWOOD, KATHLEEN (LMP)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:5213 PACIFIC AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7695
Mailing Address - Country:US
Mailing Address - Phone:253-474-1234
Mailing Address - Fax:253-474-1942
Practice Address - Street 1:5213 PACIFIC AVE STE 3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7695
Practice Address - Country:US
Practice Address - Phone:253-474-1234
Practice Address - Fax:253-474-1942
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAUNDERKC367CR225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist