Healthcare Provider Details

I. General information

NPI: 1780929687
Provider Name (Legal Business Name): KATY CHAMBERLAIN LMP, CCT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 RIVERSIDE DR STE 105
MOUNT VERNON WA
98273
US

IV. Provider business mailing address

2218 CEDAR LN
SEDRO WOOLLEY WA
98284-9496
US

V. Phone/Fax

Practice location:
  • Phone: 360-424-6104
  • Fax:
Mailing address:
  • Phone: 360-202-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60303226
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501010961
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: