Provider Demographics
NPI:1689715203
Name:TALBOT, KARA (LMT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-1066
Mailing Address - Country:US
Mailing Address - Phone:360-434-3381
Mailing Address - Fax:
Practice Address - Street 1:9095 MCCONNELL AVE NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9095
Practice Address - Country:US
Practice Address - Phone:360-434-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA9950225700000X
WAMA00009950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist