Provider Demographics
NPI:1225164809
Name:KUNKEL, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOAN
Other - Last Name:KUNKEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 9358
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99209-9358
Mailing Address - Country:US
Mailing Address - Phone:509-926-3590
Mailing Address - Fax:509-467-2289
Practice Address - Street 1:605 E HOLLAND AVE
Practice Address - Street 2:STE 114
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2225
Practice Address - Country:US
Practice Address - Phone:509-340-1000
Practice Address - Fax:509-467-2289
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004375225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist