Provider Demographics
NPI:1609498500
Name:MAYCUMBER, KELLY MELISSA (LRCP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MELISSA
Last Name:MAYCUMBER
Suffix:
Gender:F
Credentials:LRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 FRASER ST
Mailing Address - Street 2:BLDG M-106
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-8709
Mailing Address - Country:US
Mailing Address - Phone:360-946-2828
Mailing Address - Fax:
Practice Address - Street 1:1501 FRASER ST
Practice Address - Street 2:BLDG M-106
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-9822
Practice Address - Country:US
Practice Address - Phone:360-946-2828
Practice Address - Fax:360-249-9787
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALR000033152278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health