Provider Demographics
NPI:1740617836
Name:CARTER, KATHLEEN L (LMP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:L
Last Name:CARTER
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 1:650 DUVALL AVE NE APT H813
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5731
Mailing Address - Country:US
Mailing Address - Phone:425-786-7482
Mailing Address - Fax:
Practice Address - Street 1:5446 119TH AVE SE #D
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-786-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60348074225700000X
TXMT021588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist