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General NPI Number Information
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NPI Number | 1063818524
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Entity Type | Organization
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Legal Business Name | MASSAGE BY KELSEY
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Dates
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Enumeration Date | 11/11/2014
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 9510 271ST ST NW
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City | STANWOOD
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State | WA
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Zip | 98292-8095
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Country | US
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Telephone | 360-629-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 7524 208TH PL NW
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City | STANWOOD
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State | WA
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Zip | 98292-7887
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Country | US
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Telephone | 360-631-2922
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELSEY NICHOLE KANEHEN
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Credential | LMP
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Telephone | 360-631-2922
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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 | MA60510471
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License Number State | WA
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