Provider Demographics
NPI:1417148768
Name:STACY, CATHY (LMP)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:
Last Name:STACY
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 1:16545 NE 80TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3951
Mailing Address - Country:US
Mailing Address - Phone:425-885-5581
Mailing Address - Fax:425-869-9680
Practice Address - Street 1:16545 NE 80TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3951
Practice Address - Country:US
Practice Address - Phone:425-885-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist