Provider Demographics
NPI:1437734605
Name:EYTCHESON, KATHERINE E (LMT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:EYTCHESON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:EYTCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:221 RALPH AVE APT 4L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1966
Mailing Address - Country:US
Mailing Address - Phone:815-238-1024
Mailing Address - Fax:
Practice Address - Street 1:518 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3167
Practice Address - Country:US
Practice Address - Phone:718-885-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032414225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty