Provider Demographics
NPI:1982051272
Name:IRELAND, KARI LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:LYNN
Last Name:IRELAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 E MOUNTAIN VILLAGE DR
Mailing Address - Street 2:STE B PMB 258
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7373
Mailing Address - Country:US
Mailing Address - Phone:907-376-2600
Mailing Address - Fax:907-376-2605
Practice Address - Street 1:546 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7019
Practice Address - Country:US
Practice Address - Phone:907-376-2600
Practice Address - Fax:907-376-2605
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101942225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101942OtherOCCUPATIONAL LICENSE