1568601052 NPI number — MRS. KIM M HARTLEY LMP

Table of content: MRS. KIM M HARTLEY LMP (NPI 1568601052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568601052 NPI number — MRS. KIM M HARTLEY LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTLEY
Provider First Name:
KIM
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568601052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9212 WADDELL CREEK RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98512-8521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-956-1169
Provider Business Mailing Address Fax Number:
360-956-1169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9212 WADDELL CREEK RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98512-8521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-956-1169
Provider Business Practice Location Address Fax Number:
360-956-1169
Provider Enumeration Date:
02/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA-00004783 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 450029-06 . This is a "NATIONAL CERTIFICATION BOARD FOR THERAPUTIC MASSAGE AND BODYWORK (NCBTMB)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12559 . This is a "AMERICAN MASSAGE THERAPY ASSOCIATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".