Provider Demographics
NPI:1669749024
Name:KOTSOVOS-MONROE, KAREN (LMP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KOTSOVOS-MONROE
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 1:7617 278TH PL NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-4722
Mailing Address - Country:US
Mailing Address - Phone:425-344-2105
Mailing Address - Fax:
Practice Address - Street 1:7617 278TH PL NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-4722
Practice Address - Country:US
Practice Address - Phone:425-344-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60255393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist