Provider Demographics
NPI:1417233313
Name:MILLS, KATY RENEE (LMP)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:RENEE
Last Name:MILLS
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 1:30 E GRAVES RD
Mailing Address - Street 2:APT #28
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1361
Mailing Address - Country:US
Mailing Address - Phone:509-290-0044
Mailing Address - Fax:
Practice Address - Street 1:30 E GRAVES RD
Practice Address - Street 2:APT #28
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1361
Practice Address - Country:US
Practice Address - Phone:509-290-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 6024682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist