Provider Demographics
NPI:1598959330
Name:KELLEY, HEATHER JEANETTE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:JEANETTE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0371
Mailing Address - Country:US
Mailing Address - Phone:206-300-2421
Mailing Address - Fax:425-424-3256
Practice Address - Street 1:6020 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2104
Practice Address - Country:US
Practice Address - Phone:206-300-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist