Provider Demographics
NPI:1447572904
Name:MCCOY, KAREN L (LMP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:907 NW 58TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2857
Mailing Address - Country:US
Mailing Address - Phone:206-783-0340
Mailing Address - Fax:
Practice Address - Street 1:907 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2857
Practice Address - Country:US
Practice Address - Phone:206-783-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004647225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00004647OtherMASSAGE LICENSE
WA60569OtherLABOR AND INDUSTRIES, WASHINGTON STATE