Provider Demographics
NPI:1467864751
Name:KAILO BODYWORK ASSOCIATES INC
Entity Type:Organization
Organization Name:KAILO BODYWORK ASSOCIATES INC
Other - Org Name:REPOSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-734-7337
Mailing Address - Street 1:1419 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4512
Mailing Address - Country:US
Mailing Address - Phone:360-734-7337
Mailing Address - Fax:360-756-6792
Practice Address - Street 1:1419 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4512
Practice Address - Country:US
Practice Address - Phone:360-734-7337
Practice Address - Fax:360-756-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602550259225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty