Provider Demographics
NPI:1326108085
Name:BATES, KIMBERLY L (MASSAGE PACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:L
Last Name:BATES
Suffix:
Gender:F
Credentials:MASSAGE PACTITIONER
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 JADWIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4241
Mailing Address - Country:US
Mailing Address - Phone:509-943-5314
Mailing Address - Fax:509-946-5132
Practice Address - Street 1:660 JADWIN AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4241
Practice Address - Country:US
Practice Address - Phone:509-943-5314
Practice Address - Fax:509-946-5132
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist