Provider Demographics
NPI:1033431887
Name:SMITH, KRISTINE LOUISE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LOUISE
Last Name:SMITH
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 1:1400 W WASHINGTON ST STE 104
Mailing Address - Street 2:#364
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3236
Mailing Address - Country:US
Mailing Address - Phone:360-797-5832
Mailing Address - Fax:
Practice Address - Street 1:145 E WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-4107
Practice Address - Country:US
Practice Address - Phone:360-797-5832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015322225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist