Provider Demographics
NPI:1659895449
Name:BRANDT, KAYLA (LMT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2216 SHIRLEY STREET SW
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:360-791-4917
Mailing Address - Fax:
Practice Address - Street 1:2216 SHIRLEY STREET SW
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:360-791-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60779874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist