Provider Demographics
NPI:1568765956
Name:DEFREESE, KARI M (LMP)
Entity Type:Individual
Prefix:MISS
First Name:KARI
Middle Name:M
Last Name:DEFREESE
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 1:421 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE 614
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0405
Mailing Address - Country:US
Mailing Address - Phone:509-638-2113
Mailing Address - Fax:509-474-9756
Practice Address - Street 1:421 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 614
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0405
Practice Address - Country:US
Practice Address - Phone:509-638-2113
Practice Address - Fax:509-474-9756
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60168868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist