Provider Demographics
NPI:1730201351
Name:SKINNER, KYLAN ROBYN (LMP)
Entity type:Individual
Prefix:MISS
First Name:KYLAN
Middle Name:ROBYN
Last Name:SKINNER
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 1:16661 NW CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380
Mailing Address - Country:US
Mailing Address - Phone:360-271-2268
Mailing Address - Fax:
Practice Address - Street 1:19068 JENSEN WAY NE
Practice Address - Street 2:SUITE 4B
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-271-2268
Practice Address - Fax:360-779-5373
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016445225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist