Provider Demographics
NPI:1407924012
Name:PAUL, KATHERINA CARRIE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINA
Middle Name:CARRIE
Last Name:PAUL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1414
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-1414
Mailing Address - Country:US
Mailing Address - Phone:360-893-5300
Mailing Address - Fax:360-893-5314
Practice Address - Street 1:215 WHITESELL ST NW
Practice Address - Street 2:STE. C102
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9329
Practice Address - Country:US
Practice Address - Phone:360-893-5300
Practice Address - Fax:360-893-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019047225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist