Provider Demographics
NPI:1417251869
Name:CASTILLO, KAYLEE RENE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:RENE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:KAYLEE
Other - Middle Name:RENE
Other - Last Name:BRINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:3837 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2138
Mailing Address - Country:US
Mailing Address - Phone:360-473-7712
Mailing Address - Fax:
Practice Address - Street 1:3837 S 12TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:360-473-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60204696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist