Provider Demographics
NPI:1093906901
Name:DYER, KERRY J (LMP, LAC)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:J
Last Name:DYER
Suffix:
Gender:F
Credentials:LMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2508 66TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-1505
Mailing Address - Country:US
Mailing Address - Phone:360-951-3337
Mailing Address - Fax:360-736-4159
Practice Address - Street 1:1820 BLACK LAKE BLVD SW STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5619
Practice Address - Country:US
Practice Address - Phone:360-350-6610
Practice Address - Fax:360-299-5177
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002782171100000X
WAMA 00011217225700000X
WAAC 00002782171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist