Provider Demographics
NPI:1891936894
Name:MCGRATH, KIMBERLEE A
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:A
Last Name:MCGRATH
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 1:802 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-4406
Mailing Address - Country:US
Mailing Address - Phone:360-501-4378
Mailing Address - Fax:360-578-1550
Practice Address - Street 1:802 ALLEN ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-4406
Practice Address - Country:US
Practice Address - Phone:360-501-4378
Practice Address - Fax:360-578-1550
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00024222225700000X
WAMA 0022867225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist