Provider Demographics
NPI:1467784272
Name:SNYDER, KATHLEEN MORIARTY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MORIARTY
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:M
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:15303 WESTSIDE HWY SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-4015
Mailing Address - Country:US
Mailing Address - Phone:206-567-4518
Mailing Address - Fax:
Practice Address - Street 1:17429 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4653
Practice Address - Country:US
Practice Address - Phone:206-463-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60056176172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker