Provider Demographics
NPI:1437703212
Name:SMITH, KIMBERLY L (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:ALLBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2707 SILESIA LN APT C
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3664
Mailing Address - Country:US
Mailing Address - Phone:360-306-1647
Mailing Address - Fax:
Practice Address - Street 1:2707 SILESIA LN APT C
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3664
Practice Address - Country:US
Practice Address - Phone:360-306-1647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60977156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist