Provider Demographics
NPI:1043656440
Name:HARRISON, KELSEY PATRICIA (LMP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:PATRICIA
Last Name:HARRISON
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 1:13215 NE 123RD ST
Mailing Address - Street 2:322
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9307
Mailing Address - Country:US
Mailing Address - Phone:509-540-6991
Mailing Address - Fax:
Practice Address - Street 1:4122 FACTORIA BLVD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4200
Practice Address - Country:US
Practice Address - Phone:425-590-9619
Practice Address - Fax:425-590-9641
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60361108225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist