Provider Demographics
NPI:1710167960
Name:WHITE, KARA M (LMP)
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:KARA
Other - Middle Name:M
Other - Last Name:ZACHARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1408 LAKE TAPPS PKWY E
Mailing Address - Street 2:SUITE E106
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8158
Mailing Address - Country:US
Mailing Address - Phone:253-939-7179
Mailing Address - Fax:
Practice Address - Street 1:1408 LAKE TAPPS PKWY E
Practice Address - Street 2:SUITE E106
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8158
Practice Address - Country:US
Practice Address - Phone:253-939-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024856225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist