Provider Demographics
NPI:1003234733
Name:HANLEY, KISHA (LMP)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 PEACHTREE LN APT 4
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8485
Mailing Address - Country:US
Mailing Address - Phone:509-440-2808
Mailing Address - Fax:
Practice Address - Street 1:5219 W CLEARWATER AVE STE 1
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1914
Practice Address - Country:US
Practice Address - Phone:509-440-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60422398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist