=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568274520
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAILA MARIE KOONS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2025
-----------------------------------------------------
Last Update Date | 01/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 621 9TH ST
-----------------------------------------------------
City | BENTON CITY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99320-9790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-572-5613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245104 E 654 PR SE
-----------------------------------------------------
City | KENNEWICK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99337-7724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-572-5613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA61637080
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------