Provider Demographics
NPI:1740517689
Name:POLSON, KARRYN LYNN (LMP)
Entity type:Individual
Prefix:
First Name:KARRYN
Middle Name:LYNN
Last Name:POLSON
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 1:101 11TH ST NE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4481
Mailing Address - Country:US
Mailing Address - Phone:509-886-0131
Mailing Address - Fax:509-884-8153
Practice Address - Street 1:101 11TH ST NE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4481
Practice Address - Country:US
Practice Address - Phone:509-886-0131
Practice Address - Fax:509-884-8153
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60084749225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist