Provider Demographics
NPI:1417177874
Name:BARABBA, KELLI ANNE (LMP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANNE
Last Name:BARABBA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N 30TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3361
Mailing Address - Country:US
Mailing Address - Phone:253-627-5199
Mailing Address - Fax:253-627-3433
Practice Address - Street 1:2201 N 30TH ST STE C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3361
Practice Address - Country:US
Practice Address - Phone:253-627-5199
Practice Address - Fax:253-627-3433
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008871225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist