Provider Demographics
NPI:1104036037
Name:HIGGINS, KRISTIN MARIE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARIE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:13210 GOODNOUGH DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8639
Mailing Address - Country:US
Mailing Address - Phone:253-579-2412
Mailing Address - Fax:253-251-7361
Practice Address - Street 1:15404 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2642
Practice Address - Country:US
Practice Address - Phone:253-579-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019859225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA168525OtherAMA MEMBERSHIP
WAMA00019859OtherWA STATE LICENSE