Healthcare Provider Details

I. General information

NPI: 1396442570
Provider Name (Legal Business Name): KIMBERLY JANE MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S RACE ST STE C
PORT ANGELES WA
98362-6400
US

IV. Provider business mailing address

509 N BARR RD
PORT ANGELES WA
98362-8483
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-7636
  • Fax:
Mailing address:
  • Phone: 360-460-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: