Provider Demographics
NPI:1275746323
Name:BARE, KAY DEE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:DEE
Last Name:BARE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 N MULLAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6848
Mailing Address - Country:US
Mailing Address - Phone:509-777-2225
Mailing Address - Fax:509-777-2227
Practice Address - Street 1:100 N MULLAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6848
Practice Address - Country:US
Practice Address - Phone:509-777-2225
Practice Address - Fax:509-777-2227
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist