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General NPI Number Information
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NPI Number | 1023890472
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Entity Type | Individual
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Provider Name | KYLIE CRISWELL LMT
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Gender | Female
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 4027 21ST AVE W STE 201
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City | SEATTLE
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State | WA
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Zip | 98199-1272
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Country | US
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Telephone | 206-594-3900
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Fax | 833-847-6841
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Provider Business Mailing Address
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Address Line | 3800 AURORA AVE N APT 307
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City | SEATTLE
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State | WA
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Zip | 98103-8734
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Country | US
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Telephone | 831-566-8370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 61492783
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License Number State | WA
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