Healthcare Provider Details

I. General information

NPI: 1922410315
Provider Name (Legal Business Name): KELLI MCKEOWN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2749 152ND AVE NE BLDG 4H
REDMOND WA
98052-5555
US

IV. Provider business mailing address

27028 SE 170TH ST
ISSAQUAH WA
98027-8268
US

V. Phone/Fax

Practice location:
  • Phone: 253-722-3306
  • Fax:
Mailing address:
  • Phone: 253-722-3306
  • Fax: 253-722-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60468045
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: