Provider Demographics
NPI:1306065925
Name:STREET, KARRI J (LMP)
Entity type:Individual
Prefix:MRS
First Name:KARRI
Middle Name:J
Last Name:STREET
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:KARRI
Other - Middle Name:J
Other - Last Name:STREET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:6059 BARR RD
Mailing Address - Street 2:PO BOX 2925
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8747
Mailing Address - Country:US
Mailing Address - Phone:360-220-0795
Mailing Address - Fax:360-312-0514
Practice Address - Street 1:6059 BARR RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8747
Practice Address - Country:US
Practice Address - Phone:360-220-0795
Practice Address - Fax:360-312-0514
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist