Provider Demographics
NPI:1033488523
Name:KELLOUGH, BELINDA ALICE (LMP)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:ALICE
Last Name:KELLOUGH
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 1:1207 SE RASMUSSEN BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-8618
Mailing Address - Country:US
Mailing Address - Phone:971-284-9006
Mailing Address - Fax:
Practice Address - Street 1:1207 SE RASMUSSEN BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-8618
Practice Address - Country:US
Practice Address - Phone:971-284-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60263229225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist