Provider Demographics
NPI:1689049454
Name:STAPLES, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:STAPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 EVERGREEN WAY STE 601
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2062
Mailing Address - Country:US
Mailing Address - Phone:360-835-9911
Mailing Address - Fax:360-835-5764
Practice Address - Street 1:3307 EVERGREEN WAY STE 601
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2062
Practice Address - Country:US
Practice Address - Phone:360-835-9911
Practice Address - Fax:360-835-5764
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60610695225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist