Provider Demographics
NPI:1558581488
Name:VOTAVA, KATIE (LMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:VOTAVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6336
Mailing Address - Country:US
Mailing Address - Phone:253-332-0457
Mailing Address - Fax:206-244-2613
Practice Address - Street 1:2120 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2027
Practice Address - Country:US
Practice Address - Phone:206-244-7973
Practice Address - Fax:206-244-2613
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0210143OtherWORKER'S COMP