Provider Demographics
NPI:1164860334
Name:LOPEZ, KAMI LEE (LMP)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:LEE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:LEE
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:432 VOLESKY CIR SE
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-9561
Mailing Address - Country:US
Mailing Address - Phone:360-359-8638
Mailing Address - Fax:
Practice Address - Street 1:432 VOLESKY CIR SE
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:WA
Practice Address - Zip Code:98576-9561
Practice Address - Country:US
Practice Address - Phone:360-359-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60388712225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist