Provider Demographics
NPI:1245085760
Name:GOMEZ, KAORI DOMINIQUE (LMT)
Entity type:Individual
Prefix:
First Name:KAORI
Middle Name:DOMINIQUE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15404 E SPRINGFIELD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8569
Mailing Address - Country:US
Mailing Address - Phone:509-892-9800
Mailing Address - Fax:509-892-9998
Practice Address - Street 1:15404 E SPRINGFIELD AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8569
Practice Address - Country:US
Practice Address - Phone:509-892-9800
Practice Address - Fax:509-892-9998
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61081802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist