Provider Demographics
NPI:1396333415
Name:LAMB, SIERRA KELLY (MT)
Entity type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:KELLY
Last Name:LAMB
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MRS
Other - First Name:SIERRA
Other - Middle Name:KELLY
Other - Last Name:SCHWANEBECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT
Mailing Address - Street 1:1347 H ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2334
Mailing Address - Country:US
Mailing Address - Phone:719-293-3860
Mailing Address - Fax:
Practice Address - Street 1:129 1/2 W 3RD ST STE 8
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2042
Practice Address - Country:US
Practice Address - Phone:719-293-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023194225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist