Provider Demographics
NPI:1639836166
Name:PARKER, KATIE CAROLINE (LMBT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:CAROLINE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 LEIGH FARM RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7195
Mailing Address - Country:US
Mailing Address - Phone:252-312-6942
Mailing Address - Fax:
Practice Address - Street 1:217 S POINDEXTER ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4834
Practice Address - Country:US
Practice Address - Phone:252-312-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist