Provider Demographics
NPI:1841702172
Name:HARRISON, KIE-SHA MASHELLE
Entity type:Individual
Prefix:
First Name:KIE-SHA
Middle Name:MASHELLE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:UNALASKA
Mailing Address - State:AK
Mailing Address - Zip Code:99685-0208
Mailing Address - Country:US
Mailing Address - Phone:907-581-3550
Mailing Address - Fax:907-581-5055
Practice Address - Street 1:372 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:UNALASKA
Practice Address - State:AK
Practice Address - Zip Code:99685-0208
Practice Address - Country:US
Practice Address - Phone:907-581-3550
Practice Address - Fax:907-581-5055
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist