Provider Demographics
NPI:1629649090
Name:SWANBURG, KAITLYN (LMT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SWANBURG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:PACHOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2614 E ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-1714
Mailing Address - Country:US
Mailing Address - Phone:360-207-0134
Mailing Address - Fax:
Practice Address - Street 1:2614 E ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-1714
Practice Address - Country:US
Practice Address - Phone:360-207-0134
Practice Address - Fax:360-208-0520
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist