Provider Demographics
NPI:1285873265
Name:BEAIRD, KALI MAE
Entity type:Individual
Prefix:MRS
First Name:KALI
Middle Name:MAE
Last Name:BEAIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALI
Other - Middle Name:MAE
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:219 Y ST SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5211
Mailing Address - Country:US
Mailing Address - Phone:360-791-5913
Mailing Address - Fax:
Practice Address - Street 1:219 Y ST SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5211
Practice Address - Country:US
Practice Address - Phone:360-791-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60055560225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist