Provider Demographics
NPI:1649504655
Name:TROUT, KELSEY MARGARET
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARGARET
Last Name:TROUT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:MARGARET
Other - Last Name:TROUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:7627 DENALI AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516
Mailing Address - Country:US
Mailing Address - Phone:509-989-3150
Mailing Address - Fax:
Practice Address - Street 1:24160 NE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9626
Practice Address - Country:US
Practice Address - Phone:360-205-3085
Practice Address - Fax:360-275-2007
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60096383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist