Provider Demographics
NPI:1518224690
Name:LUND, KATHY (LMP)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:LUND
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:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-1150
Mailing Address - Country:US
Mailing Address - Phone:360-480-9505
Mailing Address - Fax:
Practice Address - Street 1:503 1ST ST S
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7634
Practice Address - Country:US
Practice Address - Phone:360-480-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60268549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60268549OtherLICENSED MASSAGE PRACTITIONER