Healthcare Provider Details

I. General information

NPI: 1306969332
Provider Name (Legal Business Name): CASILDRA J KUMMER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY KUMMER LMP

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 VETERANS AVE
WESTPORT WA
98595
US

IV. Provider business mailing address

PO BOX 773
WESTPORT WA
98595
US

V. Phone/Fax

Practice location:
  • Phone: 360-268-0201
  • Fax:
Mailing address:
  • Phone: 360-268-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA0014367
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: