Provider Demographics
NPI:1578889606
Name:STANDON, KAILA KATHLEEN (LMP MA 60012873)
Entity Type:Individual
Prefix:MRS
First Name:KAILA
Middle Name:KATHLEEN
Last Name:STANDON
Suffix:
Gender:F
Credentials:LMP MA 60012873
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:KATHLEEN
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9909 168TH ST E
Mailing Address - Street 2:#102
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375
Mailing Address - Country:US
Mailing Address - Phone:253-445-3000
Mailing Address - Fax:
Practice Address - Street 1:9909 168TH ST E
Practice Address - Street 2:#102
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375
Practice Address - Country:US
Practice Address - Phone:253-445-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60012873225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist