Provider Demographics
NPI:1033582473
Name:BELL, BROOKE KENDRICK (LMP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:KENDRICK
Last Name:BELL
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:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0475
Mailing Address - Country:US
Mailing Address - Phone:360-359-4837
Mailing Address - Fax:
Practice Address - Street 1:1626 GLASS AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4508
Practice Address - Country:US
Practice Address - Phone:360-349-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60453759225700000X
WAAC.61209299171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist