Provider Demographics
NPI:1134311467
Name:KOHLER, KRISTEN L (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:KOHLER
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 1:13118 121ST WAY NE STE 100
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3004
Mailing Address - Country:US
Mailing Address - Phone:425-820-2773
Mailing Address - Fax:
Practice Address - Street 1:13118 121ST WAY NE STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3004
Practice Address - Country:US
Practice Address - Phone:425-820-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00009723OtherWA STATE DEPT OF HEALTH