Provider Demographics
NPI:1780752766
Name:DEVRIES, KATRINA ELIZABETH (LMP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ELIZABETH
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:ELIZABETH
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1523 SOUTH PERRY STREET
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203
Mailing Address - Country:US
Mailing Address - Phone:509-315-9233
Mailing Address - Fax:509-315-9480
Practice Address - Street 1:1523 SOUTH PERRY STREET
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203
Practice Address - Country:US
Practice Address - Phone:509-315-9233
Practice Address - Fax:509-315-9480
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0214518OtherLABOR AND INDUSTRIES