Provider Demographics
NPI:1881044592
Name:CONROY, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CONROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 NE STATE HIGHWAY 104
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9454
Mailing Address - Country:US
Mailing Address - Phone:360-297-0037
Mailing Address - Fax:360-297-0420
Practice Address - Street 1:8202 NE STATE HIGHWAY 104
Practice Address - Street 2:SUITE 105
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9454
Practice Address - Country:US
Practice Address - Phone:360-297-0037
Practice Address - Fax:360-297-0420
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60615549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist