Provider Demographics
NPI:1427256155
Name:PARKER, KATELYN JACKIE (LMP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:JACKIE
Last Name:PARKER
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 1:2512 NUMBER 1 CANYON RD # #
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2423
Mailing Address - Country:US
Mailing Address - Phone:509-860-4565
Mailing Address - Fax:509-663-5073
Practice Address - Street 1:1601 N WENATCHEE AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1158
Practice Address - Country:US
Practice Address - Phone:509-667-2720
Practice Address - Fax:509-663-5073
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist