Provider Demographics
NPI:1366723009
Name:TOOKER, KATHRYN CORELL (LAC, MACOM, EAMP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CORELL
Last Name:TOOKER
Suffix:
Gender:F
Credentials:LAC, MACOM, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 NW 60TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2035
Mailing Address - Country:US
Mailing Address - Phone:206-518-7631
Mailing Address - Fax:
Practice Address - Street 1:1407 NW 70TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117
Practice Address - Country:US
Practice Address - Phone:206-518-7631
Practice Address - Fax:888-608-9987
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60241130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist