Healthcare Provider Details

I. General information

NPI: 1164959771
Provider Name (Legal Business Name): JORDAN KEHNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 ELMWAY
OKANOGAN WA
98840-9629
US

IV. Provider business mailing address

744 W RIDGE DR
OMAK WA
98841-9520
US

V. Phone/Fax

Practice location:
  • Phone: 509-322-6090
  • Fax:
Mailing address:
  • Phone: 509-322-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60720987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: