Provider Demographics
NPI:1154613198
Name:MAUK, KALYN C (CMT)
Entity type:Individual
Prefix:MRS
First Name:KALYN
Middle Name:C
Last Name:MAUK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MRS
Other - First Name:KALYN
Other - Middle Name:C
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:2366 N RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7518
Mailing Address - Country:US
Mailing Address - Phone:208-859-7542
Mailing Address - Fax:
Practice Address - Street 1:2366 N RAYMOND ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7518
Practice Address - Country:US
Practice Address - Phone:208-859-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID110099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNCMR3OtherBLUE CROSS OF IDAHO