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General NPI Number Information
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NPI Number | 1679312284
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Entity Type | Individual
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Provider Name | KAYLEE WILLMAN
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Gender | Female
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 26076 IOWA AVE NE # B-1
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City | KINGSTON
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State | WA
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Zip | 98346-9683
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Country | US
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Telephone | 360-271-8806
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Fax |
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Provider Business Mailing Address
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Address Line | 8202 NE STATE HWY 104 SUITE 102, PMB 140
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City | KINGSTON
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State | WA
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Zip | 98346
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Country | US
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Telephone | 360-271-8806
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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 | MA61414790
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License Number State | WA
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