Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60422398 | WA |
NPI | 1003234733 |
---|---|
Provider Name | Kisha Hanley |
First Address | Richland, WA 99352-8485 |
Second Address | Kennewick, WA 99336-1914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 09/10/2020 |