Provider Demographics
NPI:1427326230
Name:EDMISTON, CATREECE
Entity type:Individual
Prefix:
First Name:CATREECE
Middle Name:
Last Name:EDMISTON
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 1:81673 HARBOR LITE DR
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-6257
Mailing Address - Country:US
Mailing Address - Phone:541-561-3718
Mailing Address - Fax:
Practice Address - Street 1:81673 HARBOR LITE DR
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882-6257
Practice Address - Country:US
Practice Address - Phone:541-561-3718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60213150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist