=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639279797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN MARIN COLLINS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 12/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12911 120TH AVE NE #C-50
-----------------------------------------------------
City | KRIKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-899-4100
-----------------------------------------------------
Fax | 425-899-4243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12911 120TH AVE NE #C-50
-----------------------------------------------------
City | KRIKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-899-4100
-----------------------------------------------------
Fax | 425-899-4243
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | MD00018326
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------