Provider Demographics
NPI:1821253923
Name:KAKOCZKY, CAROL ANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:KAKOCZKY
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 1:545 RAINIER BLVD N
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2806
Mailing Address - Country:US
Mailing Address - Phone:425-802-2826
Mailing Address - Fax:425-837-0693
Practice Address - Street 1:545 RAINIER BLVD N
Practice Address - Street 2:SUITE 9
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2806
Practice Address - Country:US
Practice Address - Phone:425-802-2826
Practice Address - Fax:425-837-0693
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00009890225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist