Provider Demographics
NPI:1659883817
Name:KAISER, LORENA ALEHLY (MA#00020140)
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:ALEHLY
Last Name:KAISER
Suffix:
Gender:F
Credentials:MA#00020140
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 63RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-9515
Mailing Address - Country:US
Mailing Address - Phone:425-293-1914
Mailing Address - Fax:
Practice Address - Street 1:2804 GRAND AVE STE 307A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3586
Practice Address - Country:US
Practice Address - Phone:425-293-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist