=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578857439
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE LYNN KLINSKI L.M.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2011
-----------------------------------------------------
Last Update Date | 01/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 KENYON ST NW SUITE 7
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98502-4553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-250-8568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1716 GLASS AVE NE
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98506-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-250-8568
-----------------------------------------------------
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 | MA60190795
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------