Provider Demographics
NPI:1679361364
Name:KATZAKIAN-MCCORNACK, KATELYN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:KATZAKIAN-MCCORNACK
Suffix:
Gender:
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-1799
Mailing Address - Country:US
Mailing Address - Phone:707-832-2929
Mailing Address - Fax:707-968-4779
Practice Address - Street 1:350 E ST
Practice Address - Street 2:SUITE 205 & 210
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-832-2929
Practice Address - Fax:707-968-4779
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist