Provider Demographics
NPI:1417453911
Name:STEWART, KATHARINE (LAC)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-6917
Mailing Address - Country:US
Mailing Address - Phone:971-320-4217
Mailing Address - Fax:
Practice Address - Street 1:10 N HOLLADAY DR STE B
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6853
Practice Address - Country:US
Practice Address - Phone:971-320-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR181290171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist