Provider Demographics
NPI:1689293029
Name:HODGES, KATHRYN EMILY (LMT, NMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EMILY
Last Name:HODGES
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 2ND AVENUE EAST N
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4103
Mailing Address - Country:US
Mailing Address - Phone:406-460-2712
Mailing Address - Fax:
Practice Address - Street 1:178 2ND AVENUE EAST N
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4103
Practice Address - Country:US
Practice Address - Phone:406-450-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-11627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty