Healthcare Provider Details

I. General information

NPI: 1336622000
Provider Name (Legal Business Name): SONJA ERIKA KALAMA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 E YELM AVE
YELM WA
98597-8328
US

IV. Provider business mailing address

314 MOSMAN AVE SW
YELM WA
98597-7632
US

V. Phone/Fax

Practice location:
  • Phone: 360-458-7533
  • Fax:
Mailing address:
  • Phone: 360-888-2165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60521792
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: