Provider Demographics
NPI:1407548498
Name:AMOS, KATELYNNE SIERRA (LMT)
Entity Type:Individual
Prefix:
First Name:KATELYNNE
Middle Name:SIERRA
Last Name:AMOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATELYNNE
Other - Middle Name:SIERRA
Other - Last Name:ZABEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 SHADOW FERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6651
Mailing Address - Country:US
Mailing Address - Phone:843-412-2061
Mailing Address - Fax:
Practice Address - Street 1:2121 SHADOW FERRY DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6651
Practice Address - Country:US
Practice Address - Phone:843-412-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist