Provider Demographics
NPI:1821170689
Name:MCMAHON, KATRINA E (LMT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:E
Last Name:MCMAHON
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 1:1 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4819
Mailing Address - Country:US
Mailing Address - Phone:207-623-6340
Mailing Address - Fax:207-623-6340
Practice Address - Street 1:1 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4819
Practice Address - Country:US
Practice Address - Phone:207-623-6340
Practice Address - Fax:207-623-6340
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2211175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath