Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00019643 | WA |
NPI | 1013080480 |
---|---|
Provider Name | Ms. Kimberly Mae Allen |
First Address | Burien, WA 98148-1107 |
Second Address | Burien, WA 98148-1107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 18/02/2011 |