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General NPI Number Information
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NPI Number | 1104286921
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Entity Type | Individual
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Provider Name | KALENA ANNA SOARES-KAKULU LMT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 7503 144TH ST E
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City | PUYALLUP
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State | WA
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Zip | 98375-8269
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Country | US
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Telephone | 360-970-6309
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Fax |
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Provider Business Mailing Address
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Address Line | 8839 DAFFODIL LN SE
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City | OLYMPIA
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State | WA
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Zip | 98513-1767
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Country | US
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Telephone | 360-706-9204
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | M00022974
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00022974
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License Number State | WA
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