Provider Demographics
NPI:1659895449
Name:LORD, KAYLA (LMT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5750 RUDDELL RD SE STE B
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5100
Mailing Address - Country:US
Mailing Address - Phone:360-412-8286
Mailing Address - Fax:360-412-7403
Practice Address - Street 1:5750 RUDDELL RD SE STE B
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5100
Practice Address - Country:US
Practice Address - Phone:360-412-8286
Practice Address - Fax:360-412-7403
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60779874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist