Provider Demographics
NPI:1790445773
Name:CRANDELL, KATE ESTHER (LMT)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:ESTHER
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BJUNE DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2459
Mailing Address - Country:US
Mailing Address - Phone:206-842-3222
Mailing Address - Fax:
Practice Address - Street 1:123 BJUNE DR SE STE 101
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2459
Practice Address - Country:US
Practice Address - Phone:206-842-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61216742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist