Provider Demographics
NPI:1457758104
Name:MURDOCH, KARISSA ASHLEY (LMT)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:ASHLEY
Last Name:MURDOCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:ASHLEY
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:311 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:WINLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98596-9777
Mailing Address - Country:US
Mailing Address - Phone:360-520-9302
Mailing Address - Fax:
Practice Address - Street 1:1015 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1713
Practice Address - Country:US
Practice Address - Phone:360-520-9302
Practice Address - Fax:360-669-5130
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60508775225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist