Healthcare Provider Details

I. General information

NPI: 1710699376
Provider Name (Legal Business Name): KELSEY KUHN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E 8TH ST STE D
PORT ANGELES WA
98362-6251
US

IV. Provider business mailing address

1012 W 10TH ST
PORT ANGELES WA
98363-5732
US

V. Phone/Fax

Practice location:
  • Phone: 360-207-1655
  • Fax:
Mailing address:
  • Phone: 231-499-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.61332742
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: