Provider Demographics
NPI:1487094025
Name:THOMPSON, KATELYN (LMP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:IVELIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14200 N CREEK DR
Mailing Address - Street 2:UNIT 2035
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5378
Mailing Address - Country:US
Mailing Address - Phone:425-422-4802
Mailing Address - Fax:
Practice Address - Street 1:15603 MAIN ST
Practice Address - Street 2:SUITE B-106
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9003
Practice Address - Country:US
Practice Address - Phone:425-948-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60237727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist