Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT00010618 | WA |
Y | 213ES0000X | Sports Medicine | PT00010618 | WA |
NPI | 1063601375 |
---|---|
Provider Name | Ms. Kathleen Elizabeth Severeid |
First Address | Seattle, WA 98124-1584 |
Second Address | Tacoma, WA 98405-4265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 18/03/2008 |