Healthcare Provider Details

I. General information

NPI: 1528239647
Provider Name (Legal Business Name): KRISTY J SEELYE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 W EVERGREEN FARM WAY #6065
SEQUIM WA
98382-5097
US

IV. Provider business mailing address

209 ORCAS AVE
PORT ANGELES WA
98362-6531
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-9977
  • Fax: 360-582-9972
Mailing address:
  • Phone: 360-775-7374
  • Fax: 360-582-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017716
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: