Provider Demographics
NPI:1437483542
Name:STEVENS, KELSY SHERREE
Entity Type:Individual
Prefix:MRS
First Name:KELSY
Middle Name:SHERREE
Last Name:STEVENS
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 1:1241 STATE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3612
Mailing Address - Country:US
Mailing Address - Phone:360-659-9659
Mailing Address - Fax:
Practice Address - Street 1:1241 STATE AVE STE 103
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3612
Practice Address - Country:US
Practice Address - Phone:360-659-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60104568225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist