Healthcare Provider Details

I. General information

NPI: 1790649903
Provider Name (Legal Business Name): KAI MICAH ROBBINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 THOMAS JOHNSON DR STE 105
FREDERICK MD
21702-4498
US

IV. Provider business mailing address

176 THOMAS JOHNSON DR STE 105
FREDERICK MD
21702-4498
US

V. Phone/Fax

Practice location:
  • Phone: 240-242-5498
  • Fax:
Mailing address:
  • Phone: 240-242-5498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM05217
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: