Provider Demographics
NPI:1881993822
Name:FOCHT, MARYKATHRINE (LMP)
Entity type:Individual
Prefix:
First Name:MARYKATHRINE
Middle Name:
Last Name:FOCHT
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 1:4496 248TH LN SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-6400
Mailing Address - Country:US
Mailing Address - Phone:425-890-6937
Mailing Address - Fax:
Practice Address - Street 1:5712 E. LAKE SAMMAMISH PKWY S.E
Practice Address - Street 2:SUITE 106
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-2613
Practice Address - Country:US
Practice Address - Phone:425-270-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019762225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist