Provider Demographics
NPI:1568692192
Name:KIMBALL, KATIE FAY (LMP)
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:FAY
Last Name:KIMBALL
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 1:320 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2107
Mailing Address - Country:US
Mailing Address - Phone:509-663-5244
Mailing Address - Fax:509-664-6508
Practice Address - Street 1:320 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2107
Practice Address - Country:US
Practice Address - Phone:509-663-5244
Practice Address - Fax:509-664-6508
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60060117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist