Provider Demographics
NPI:1669081246
Name:NICHOLAS, KATHRYN ARLENE (LMT)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ARLENE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0203
Mailing Address - Country:US
Mailing Address - Phone:509-218-5200
Mailing Address - Fax:509-935-2273
Practice Address - Street 1:18609 E MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-8538
Practice Address - Country:US
Practice Address - Phone:509-218-5200
Practice Address - Fax:509-935-2273
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61065268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist