Provider Demographics
NPI:1932354057
Name:HORN, KELLY LEONARD (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LEONARD
Last Name:HORN
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 1:2205 247TH CT NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98074-3342
Mailing Address - Country:US
Mailing Address - Phone:425-466-9116
Mailing Address - Fax:
Practice Address - Street 1:12951 BEL RED RD STE 120
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2628
Practice Address - Country:US
Practice Address - Phone:425-466-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60018819225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist