Provider Demographics
NPI:1578618880
Name:MARKHAM, KATHERINE D (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:D
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:D
Other - Last Name:MARKHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 1443
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-1443
Mailing Address - Country:US
Mailing Address - Phone:253-797-2114
Mailing Address - Fax:360-825-4645
Practice Address - Street 1:1737 WELLS ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3518
Practice Address - Country:US
Practice Address - Phone:360-825-7549
Practice Address - Fax:360-825-4645
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist