Provider Demographics
NPI:1629191408
Name:ROFF, KARLYN A (LMP)
Entity Type:Individual
Prefix:
First Name:KARLYN
Middle Name:A
Last Name:ROFF
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:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-0133
Mailing Address - Country:US
Mailing Address - Phone:360-862-9573
Mailing Address - Fax:360-862-9572
Practice Address - Street 1:265 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2516
Practice Address - Country:US
Practice Address - Phone:360-862-9573
Practice Address - Fax:360-862-9572
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist