Provider Demographics
NPI:1447896527
Name:BUCKLER, KAMI JUSTINE (MA 61019563)
Entity type:Individual
Prefix:
First Name:KAMI
Middle Name:JUSTINE
Last Name:BUCKLER
Suffix:
Gender:F
Credentials:MA 61019563
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9677
Mailing Address - Country:US
Mailing Address - Phone:509-985-8616
Mailing Address - Fax:
Practice Address - Street 1:4110 TERRACE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1429
Practice Address - Country:US
Practice Address - Phone:509-823-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61019563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist