Provider Demographics
NPI:1831226109
Name:CARTER, KATHLENE JO (LMP)
Entity type:Individual
Prefix:MISS
First Name:KATHLENE
Middle Name:JO
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2801 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9088
Mailing Address - Country:US
Mailing Address - Phone:253-640-2340
Mailing Address - Fax:253-874-3601
Practice Address - Street 1:34507 PACIFIC HWY S STE 4
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6879
Practice Address - Country:US
Practice Address - Phone:253-874-4141
Practice Address - Fax:253-874-3601
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist