Provider Demographics
NPI:1972157717
Name:LILLEY AGGERRSON, KIMBERLIE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLIE
Middle Name:
Last Name:LILLEY AGGERRSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIMBERLIE
Other - Middle Name:
Other - Last Name:LILLEY AGGERRSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1100 FERN ST SW APT 45-103
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1146
Mailing Address - Country:US
Mailing Address - Phone:360-701-2098
Mailing Address - Fax:360-485-4509
Practice Address - Street 1:1100 FERN ST SW APT 45-103
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1146
Practice Address - Country:US
Practice Address - Phone:360-701-2098
Practice Address - Fax:360-485-4509
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60967860225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist