Provider Demographics
NPI:1356601447
Name:KILMER, DESTINY (LMP)
Entity type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:
Last Name:KILMER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 NE BALLINGER PL
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1138
Mailing Address - Country:US
Mailing Address - Phone:206-478-5632
Mailing Address - Fax:
Practice Address - Street 1:10024 MAIN ST
Practice Address - Street 2:#2C
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3464
Practice Address - Country:US
Practice Address - Phone:425-485-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60280476225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist