Provider Demographics
NPI:1225191109
Name:GARRETT, KYM (LAC)
Entity Type:Individual
Prefix:
First Name:KYM
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 NE 4TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4647
Mailing Address - Country:US
Mailing Address - Phone:541-241-2361
Mailing Address - Fax:888-972-4916
Practice Address - Street 1:911 NE 4TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4647
Practice Address - Country:US
Practice Address - Phone:541-241-2361
Practice Address - Fax:888-972-4916
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00979171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist