Provider Demographics
NPI:1730346602
Name:WESTLING, KENZIE KAY (LMP)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:KAY
Last Name:WESTLING
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:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0103
Mailing Address - Country:US
Mailing Address - Phone:360-876-1500
Mailing Address - Fax:360-871-6666
Practice Address - Street 1:873 BETHEL AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4229
Practice Address - Country:US
Practice Address - Phone:360-876-1500
Practice Address - Fax:360-876-1666
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00019041225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist