=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710229091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERYN ANNE MACKEY-YEAW MT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2013
-----------------------------------------------------
Last Update Date | 03/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3381 N CAFFELL RD
-----------------------------------------------------
City | CHEWELAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99109-9432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-671-1721
-----------------------------------------------------
Fax | 509-445-0646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3381 N CAFFELL RD
-----------------------------------------------------
City | CHEWELAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99109-9432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-671-1721
-----------------------------------------------------
Fax | 509-445-0646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60332636
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------