Provider Demographics
NPI:1326406356
Name:FOWLER, KELSEA LINNAE
Entity Type:Individual
Prefix:
First Name:KELSEA
Middle Name:LINNAE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 SE WASHINGTON AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3070
Mailing Address - Country:US
Mailing Address - Phone:907-394-4692
Mailing Address - Fax:
Practice Address - Street 1:267 SE WASHINGTON AVE APT 304
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3070
Practice Address - Country:US
Practice Address - Phone:907-394-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist