Provider Demographics
NPI:1487966180
Name:KRECH, KATELYN A (LMP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:A
Last Name:KRECH
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 1:20455 1ST AVE NE
Mailing Address - Street 2:#A103
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9319
Mailing Address - Country:US
Mailing Address - Phone:360-710-9413
Mailing Address - Fax:
Practice Address - Street 1:10513 SILVERDALE WAY NW
Practice Address - Street 2:SUITE 102
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9499
Practice Address - Country:US
Practice Address - Phone:360-698-4411
Practice Address - Fax:360-698-6953
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60152367225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist