Provider Demographics
NPI:1952910861
Name:NELSON, KATHERINE J (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:SKAGWAY
Mailing Address - State:AK
Mailing Address - Zip Code:99840-0686
Mailing Address - Country:US
Mailing Address - Phone:907-612-3096
Mailing Address - Fax:
Practice Address - Street 1:1325 STATE STREET
Practice Address - Street 2:
Practice Address - City:SKAGWAY
Practice Address - State:AK
Practice Address - Zip Code:99840
Practice Address - Country:US
Practice Address - Phone:907-612-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK115588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist