Provider Demographics
NPI:1154860971
Name:STAMPER MAUSTEN, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:STAMPER MAUSTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:MAUSTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8502 237TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-5737
Mailing Address - Country:US
Mailing Address - Phone:253-226-1404
Mailing Address - Fax:
Practice Address - Street 1:22705 MERIDIAN AVE E
Practice Address - Street 2:UNIT A
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-7098
Practice Address - Country:US
Practice Address - Phone:253-875-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00016013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist