Provider Demographics
NPI:1962520551
Name:MACKEY, KATHRYN ANNE (LMP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:MACKEY
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 1:15615 BEL RED RD STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2300
Mailing Address - Country:US
Mailing Address - Phone:425-883-0133
Mailing Address - Fax:
Practice Address - Street 1:15615 BEL RED RD STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2300
Practice Address - Country:US
Practice Address - Phone:425-883-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0105603OtherLABOR & INDUSTRIES