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General NPI Number Information
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NPI Number | 1457758104
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Entity Type | Individual
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Provider Name | KARISSA ASHLEY MURDOCH LMT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1015 JOHNSON RD
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City | CENTRALIA
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State | WA
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Zip | 98531-1713
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Country | US
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Telephone | 360-520-9302
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Fax | 360-669-5130
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Provider Business Mailing Address
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Address Line | 311 CEDAR CT
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City | WINLOCK
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State | WA
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Zip | 98596-9777
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Country | US
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Telephone | 360-520-9302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60508775
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License Number State | WA
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