Doctor Name: | ALYCE KELLOGG |
NPI Number: | 1689979536 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | 60189742 |
Business Practice Address: | 17425 Vashon Hwy Sw Vashon, WA - 980704653 |
Business Phone Number: | 2062717993 |
Business Fax Number: | |
Mailing Address: | 8924 Sw Cemetery Rd, VASHON |
State: | WA |
Postal Code: | 980706202 |
Phone Number: | 2062717993 |
Fax Number: | |
NPI Enumeration Date: | 01/24/2011 |
NPI Last Update Date: | 10/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 60189742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |