Provider Demographics
NPI:1396738258
Name:O'BRIEN, KRISTIN K (LMP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:K
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:K
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:22008 51ST AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-6833
Mailing Address - Country:US
Mailing Address - Phone:253-548-5523
Mailing Address - Fax:253-845-5811
Practice Address - Street 1:16515 MERIDIAN E
Practice Address - Street 2:STE 103B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6251
Practice Address - Country:US
Practice Address - Phone:253-548-5523
Practice Address - Fax:253-845-5811
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3082MOOtherREGENCE B/S
WA8939816OtherCRIME VICTIMS
WA193033OtherDEPT OF L&I