Provider Demographics
NPI:1649573379
Name:BOWMAN, KAYLIANN MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:KAYLIANN
Middle Name:MARIE
Last Name:BOWMAN
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 1:4072 GARDENSPOT RD
Mailing Address - Street 2:
Mailing Address - City:LOON LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99148-9760
Mailing Address - Country:US
Mailing Address - Phone:509-954-1589
Mailing Address - Fax:866-629-4801
Practice Address - Street 1:707 S PARK ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7025
Practice Address - Country:US
Practice Address - Phone:509-276-8811
Practice Address - Fax:866-629-4801
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60091710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist