Provider Demographics
NPI:1639628530
Name:LIEHR, KAYLA NICOLE (LMP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:LIEHR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2305
Mailing Address - Country:US
Mailing Address - Phone:360-949-3516
Mailing Address - Fax:
Practice Address - Street 1:3400 SE 196TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8861
Practice Address - Country:US
Practice Address - Phone:360-609-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60687443225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist