Healthcare Provider Details

I. General information

NPI: 1619233988
Provider Name (Legal Business Name): KERRY J DYER LAC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COOPER POINT RD SW STE B3
OLYMPIA WA
98502-1110
US

IV. Provider business mailing address

2508 66TH AVE NE
OLYMPIA WA
98506-1505
US

V. Phone/Fax

Practice location:
  • Phone: 360-350-6610
  • Fax: 360-299-5177
Mailing address:
  • Phone: 360-350-6610
  • Fax: 360-299-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002782
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00011217
License Number StateWA

VIII. Authorized Official

Name: KERRY J DYER
Title or Position: MANAGER
Credential: LAC, LMT
Phone: 360-350-6610