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General NPI Number Information
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NPI Number | 1548646508
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Entity Type | Individual
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Provider Name | KATHRYN LEE LMT, CLT
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Gender | Female
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 742 N ADA ST UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60642
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Country | US
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Telephone | 970-209-7852
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Fax |
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Provider Business Mailing Address
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Address Line | 360 E SOUTH WATER ST # 3406
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City | CHICAGO
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State | IL
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Zip | 60601-4145
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Country | US
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Telephone | 970-209-7852
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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 | 227012174
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License Number State | IL
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