Provider Demographics
NPI:1326655770
Name:CHAMBLIN, KYLE ALEXANDER (LMT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ALEXANDER
Last Name:CHAMBLIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8063
Mailing Address - Country:US
Mailing Address - Phone:360-565-6043
Mailing Address - Fax:
Practice Address - Street 1:532 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3185
Practice Address - Country:US
Practice Address - Phone:360-683-7911
Practice Address - Fax:360-683-3981
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WA61110413225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist