Provider Demographics
NPI:1568601052
Name:HARTLEY, KIM M (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9212 WADDELL CREEK RD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-8521
Mailing Address - Country:US
Mailing Address - Phone:360-956-1169
Mailing Address - Fax:360-956-1169
Practice Address - Street 1:9212 WADDELL CREEK RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-8521
Practice Address - Country:US
Practice Address - Phone:360-956-1169
Practice Address - Fax:360-956-1169
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA-00004783225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
450029-06OtherNATIONAL CERTIFICATION BOARD FOR THERAPUTIC MASSAGE AND BODYWORK (NCBTMB)
WA12559OtherAMERICAN MASSAGE THERAPY ASSOCIATION