Provider Demographics
NPI:1811188493
Name:BAIR, KRISTINE DIANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:DIANN
Last Name:BAIR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CONSTANCE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-3500
Mailing Address - Country:US
Mailing Address - Phone:509-851-7865
Mailing Address - Fax:
Practice Address - Street 1:510 CONSTANCE AVE
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-3500
Practice Address - Country:US
Practice Address - Phone:509-851-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024375225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist