Provider Demographics
NPI:1023318342
Name:LANG, KAREN ANN (LMPLMT, MMLT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:LANG
Suffix:
Gender:F
Credentials:LMPLMT, MMLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SE 139TH AVE APT 227
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3594
Mailing Address - Country:US
Mailing Address - Phone:971-235-7864
Mailing Address - Fax:
Practice Address - Street 1:705 SE 139TH AVE APT 227
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3594
Practice Address - Country:US
Practice Address - Phone:971-235-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10656225700000X
WAMA00021893225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty