Provider Demographics
NPI:1528204773
Name:NAGUMO, KAREN L (KLM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:NAGUMO
Suffix:
Gender:F
Credentials:KLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11825 21ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2541
Mailing Address - Country:US
Mailing Address - Phone:206-755-5258
Mailing Address - Fax:
Practice Address - Street 1:2016 NE 65TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6957
Practice Address - Country:US
Practice Address - Phone:206-755-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist