Provider Demographics
NPI:1588845853
Name:HUMMEL, KYOKO M (NEW MEXICO LMT #072)
Entity Type:Individual
Prefix:
First Name:KYOKO
Middle Name:M
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:NEW MEXICO LMT #072
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 PASEO DEL PUEBLO NORTE STE B
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6483
Mailing Address - Country:US
Mailing Address - Phone:575-770-6643
Mailing Address - Fax:
Practice Address - Street 1:824 PASEO DEL PUEBLO NORTE
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-751-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0072174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist