Provider Demographics
NPI:1912422023
Name:CADY, KERRI EILEEN
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:EILEEN
Last Name:CADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10325 WHITMAN AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1763
Mailing Address - Country:US
Mailing Address - Phone:253-841-2200
Mailing Address - Fax:
Practice Address - Street 1:818 39TH AVE SW STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3308
Practice Address - Country:US
Practice Address - Phone:253-841-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60752383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60752383OtherMASSAGE LICENSE