Provider Demographics
NPI:1881724151
Name:KAWAKAMI, ELIZABETH MEDINA (LMP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MEDINA
Last Name:KAWAKAMI
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 1:8029 226TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8266
Mailing Address - Country:US
Mailing Address - Phone:425-775-0740
Mailing Address - Fax:
Practice Address - Street 1:8029 226TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8266
Practice Address - Country:US
Practice Address - Phone:425-775-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist