Provider Demographics
NPI:1467591446
Name:WARD, KATIE L (LMP)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:L
Last Name:WARD
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 1:1919 EVERGREEN PARK DR SW APT 146
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5953
Mailing Address - Country:US
Mailing Address - Phone:360-480-4363
Mailing Address - Fax:
Practice Address - Street 1:1033 1ST ST.
Practice Address - Street 2:
Practice Address - City:COSMOPOLIS
Practice Address - State:WA
Practice Address - Zip Code:98537
Practice Address - Country:US
Practice Address - Phone:360-532-1093
Practice Address - Fax:360-532-1093
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020088225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist