Provider Demographics
NPI:1386230720
Name:KIMMEL, LINDA LORI (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LORI
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LORI
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-1047
Mailing Address - Country:US
Mailing Address - Phone:206-747-2573
Mailing Address - Fax:
Practice Address - Street 1:18017 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-5205
Practice Address - Country:US
Practice Address - Phone:206-747-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60657057225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist