Provider Demographics
NPI:1740315415
Name:WETHERELL, KERRI C (LMP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:C
Last Name:WETHERELL
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 1:9222 E VALLEYWAY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6808
Mailing Address - Country:US
Mailing Address - Phone:509-435-3662
Mailing Address - Fax:509-474-0544
Practice Address - Street 1:9222 E VALLEYWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6808
Practice Address - Country:US
Practice Address - Phone:509-435-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist