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General NPI Number Information
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NPI Number | 1679361364
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Entity Type | Individual
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Provider Name | KATELYN KATZAKIAN-MCCORNACK MASSAGE THERAPIST
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Gender |
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 350 E ST SUITE 205 & 210
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City | EUREKA
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State | CA
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Zip | 95501
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Country | US
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Telephone | 707-832-2929
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Fax | 707-968-4779
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Provider Business Mailing Address
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Address Line | PO BOX 1799
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City | MENDOCINO
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State | CA
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Zip | 95460-1799
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Country | US
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Telephone | 707-832-2929
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Fax | 707-968-4779
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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 |
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License Number State |
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