Provider Demographics
NPI:1356572291
Name:MILLER, KYLEEN RAE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:KYLEEN
Middle Name:RAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307-B NE 78TH STREET SUITE #3
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:360-573-1933
Mailing Address - Fax:360-571-0143
Practice Address - Street 1:1307 NE 78TH ST STE 3
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9675
Practice Address - Country:US
Practice Address - Phone:360-573-1933
Practice Address - Fax:360-571-0143
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0018043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist