Provider Demographics
NPI:1518426618
Name:SMITH, KATE ANNE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SPICE STUDIO
Mailing Address - Street 2:22715 WASHINGTON STREET UNIT 1
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650
Mailing Address - Country:US
Mailing Address - Phone:724-953-2571
Mailing Address - Fax:
Practice Address - Street 1:22715 WASHINGTON STREET
Practice Address - Street 2:UNIT 1
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:724-953-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty