Provider Demographics
NPI:1518110097
Name:KALB, JEREMIAH MICHAEL (LMP)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:MICHAEL
Last Name:KALB
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 E GREEN LAKE WAY N APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5960
Mailing Address - Country:US
Mailing Address - Phone:206-306-4530
Mailing Address - Fax:
Practice Address - Street 1:5530 E GREEN LAKE WAY N APT 303
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5960
Practice Address - Country:US
Practice Address - Phone:206-306-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60043233225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist