Provider Demographics
NPI:1538571740
Name:RUSSELL, KAREN (LMP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32111
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-4111
Mailing Address - Country:US
Mailing Address - Phone:360-389-2103
Mailing Address - Fax:
Practice Address - Street 1:851 COHO WAY
Practice Address - Street 2:SUITE 306
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2067
Practice Address - Country:US
Practice Address - Phone:360-389-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA19824225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA283563OtherLABOR & INDUSTRIES