Provider Demographics
NPI:1982922654
Name:NELSON, KATHERINE E (LMP, NTP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMP, NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14835 PRAIRIE VISTA LOOP
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8723
Mailing Address - Country:US
Mailing Address - Phone:360-259-3368
Mailing Address - Fax:
Practice Address - Street 1:715 E YELM AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8734
Practice Address - Country:US
Practice Address - Phone:360-259-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist