Provider Demographics
NPI:1710284633
Name:WILSON-KEY, KRISTIN JANELLE
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:JANELLE
Last Name:WILSON-KEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3962 HOFF RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8532
Mailing Address - Country:US
Mailing Address - Phone:360-306-8383
Mailing Address - Fax:
Practice Address - Street 1:1209 11TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7000
Practice Address - Country:US
Practice Address - Phone:360-306-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60161972172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist