Provider Demographics
NPI:1073642997
Name:KLEYN, MARILYN
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:KLEYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:HAHNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9044 SW HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-7028
Mailing Address - Country:US
Mailing Address - Phone:206-274-7579
Mailing Address - Fax:206-463-3089
Practice Address - Street 1:17429 VASHON HWY. SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4400
Practice Address - Country:US
Practice Address - Phone:206-463-3441
Practice Address - Fax:206-463-3089
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00001022174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8340291Medicaid
WA0053521OtherLABOR AND INDUSTRIES
WAKL3228OtherBLUE SHIELD
WA0053521OtherLABOR AND INDUSTRIES