Provider Demographics
NPI:1063951069
Name:MOYER, KATIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1737
Mailing Address - Country:US
Mailing Address - Phone:907-469-1653
Mailing Address - Fax:
Practice Address - Street 1:724 WARNER ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1737
Practice Address - Country:US
Practice Address - Phone:907-469-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist