Provider Demographics
NPI:1528415262
Name:KUNKEL, LAURIE (WA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:WA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25521 E PAINTER RD
Mailing Address - Street 2:
Mailing Address - City:LATAH
Mailing Address - State:WA
Mailing Address - Zip Code:99018-9535
Mailing Address - Country:US
Mailing Address - Phone:509-283-2329
Mailing Address - Fax:
Practice Address - Street 1:25521 E PAINTER RD
Practice Address - Street 2:
Practice Address - City:LATAH
Practice Address - State:WA
Practice Address - Zip Code:99018-9535
Practice Address - Country:US
Practice Address - Phone:509-283-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60656599225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist