Provider Demographics
NPI:1205159738
Name:WOLNY, KATIE LEIGH (LMP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LEIGH
Last Name:WOLNY
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 1:9405 SW 171ST ST
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-4968
Mailing Address - Country:US
Mailing Address - Phone:206-463-0518
Mailing Address - Fax:
Practice Address - Street 1:9405 SW 171ST ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4968
Practice Address - Country:US
Practice Address - Phone:206-463-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60129820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist