Provider Demographics
NPI:1790335990
Name:HODGES, KAYLA ALANNA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ALANNA
Last Name:HODGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:ALANNA
Other - Last Name:HUTCHINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23817 109TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-8701
Mailing Address - Country:US
Mailing Address - Phone:253-209-8535
Mailing Address - Fax:253-862-6002
Practice Address - Street 1:16515 MERIDIAN E STE 103B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6252
Practice Address - Country:US
Practice Address - Phone:253-209-8535
Practice Address - Fax:253-862-6002
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240929225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist