Provider Demographics
NPI:1184864191
Name:MASON-KELLEY, RACHEL LORRAINE (LMP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LORRAINE
Last Name:MASON-KELLEY
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 1:10212 5TH AVE NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10212 5TH AVE NE
Practice Address - Street 2:SUITE 140
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7452
Practice Address - Country:US
Practice Address - Phone:206-440-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60072918172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist