Provider Demographics
NPI:1407247893
Name:BODE, KAREN (LMP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BODE
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 1:3813 V ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2626
Mailing Address - Country:US
Mailing Address - Phone:360-904-5972
Mailing Address - Fax:
Practice Address - Street 1:16508 SE 24TH ST
Practice Address - Street 2:STE 105
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4321
Practice Address - Country:US
Practice Address - Phone:971-404-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60428081225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist