Provider Demographics
NPI:1710396981
Name:DOLPH, KAILYNN MARIE (MS, ATC, AT/L)
Entity Type:Individual
Prefix:
First Name:KAILYNN
Middle Name:MARIE
Last Name:DOLPH
Suffix:
Gender:F
Credentials:MS, ATC, AT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 CRESTVIEW DR W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-2017
Mailing Address - Country:US
Mailing Address - Phone:253-226-9735
Mailing Address - Fax:
Practice Address - Street 1:54 SENTINEL DR
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-1663
Practice Address - Country:US
Practice Address - Phone:253-226-9735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60410972172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker