Provider Demographics
NPI:1871198861
Name:KATCHEM, MADDISON LEE (CMT)
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:LEE
Last Name:KATCHEM
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 BARHAM BLVD APT A106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1035
Mailing Address - Country:US
Mailing Address - Phone:310-889-4184
Mailing Address - Fax:
Practice Address - Street 1:3720 BARHAM BLVD APT A106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1035
Practice Address - Country:US
Practice Address - Phone:310-889-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist