MEDICARE: KATRINA ELIZABETH DEVRIES LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00022808	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0214518	OTHER	WA	LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1780752766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA ELIZABETH DEVRIES LMP

Provider Business Mailing Address
First Line	:	1523 SOUTH PERRY STREET
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203
Country	:	US
Telephone Number	:	509-315-9233
Fax Number	:	509-315-9480

Provider Business Practice Location Address
First Line	:	1523 SOUTH PERRY STREET
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203
Country	:	US
Telephone Number	:	509-315-9233
Fax Number	:	509-315-9480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/24/2012

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Directions to “ KATRINA ELIZABETH DEVRIES LMP” Practice Location

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