Provider Demographics
NPI:1801121157
Name:GRIFFITH, MARYKATHERINE (LMP)
Entity type:Individual
Prefix:
First Name:MARYKATHERINE
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MARY KATHERINE
Other - Middle Name:
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:611 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205
Mailing Address - Country:US
Mailing Address - Phone:509-489-2883
Mailing Address - Fax:509-487-0898
Practice Address - Street 1:611 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205
Practice Address - Country:US
Practice Address - Phone:509-489-2883
Practice Address - Fax:509-487-0898
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60104564225700000X
WAMA60104564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist