Healthcare Provider Details

I. General information

NPI: 1063697373
Provider Name (Legal Business Name): KATY GRACE BALL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2008
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 32ND AVE NE
SEATTLE WA
98125-5506
US

IV. Provider business mailing address

13027 25TH AVE NE
SEATTLE WA
98125-4240
US

V. Phone/Fax

Practice location:
  • Phone: 206-979-0509
  • Fax:
Mailing address:
  • Phone: 206-979-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: