Provider Demographics
NPI:1649484619
Name:RAY, KATIE ANN (LMP)
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:ANN
Last Name:RAY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1042 W JAMES ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4606
Mailing Address - Country:US
Mailing Address - Phone:253-852-3770
Mailing Address - Fax:253-852-3913
Practice Address - Street 1:1042 W JAMES ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4606
Practice Address - Country:US
Practice Address - Phone:253-852-3770
Practice Address - Fax:253-852-3913
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00023895OtherSTATE LICENSE