Provider Demographics
NPI:1609067818
Name:LARSON, KATHARINE (PT, BCHN)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:PT, BCHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 86TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-6260
Mailing Address - Country:US
Mailing Address - Phone:425-653-4308
Mailing Address - Fax:
Practice Address - Street 1:12301 86TH PL SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-6260
Practice Address - Country:US
Practice Address - Phone:425-653-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61214108133N00000X
WAPT00010647174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018120Medicaid