Healthcare Provider Details

I. General information

NPI: 1871897579
Provider Name (Legal Business Name): KATHLEEN DANIELLE FLYNN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 HILDEBRAND LN NE
BAINBRIDGE ISLAND WA
98110-2863
US

IV. Provider business mailing address

19085 HARRIS ST NE
SUQUAMISH WA
98392-9786
US

V. Phone/Fax

Practice location:
  • Phone: 206-842-4903
  • Fax:
Mailing address:
  • Phone: 509-429-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60192667
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: