Provider Demographics
NPI:1326187592
Name:ELTRINGHAM, KIMBERLY L (LMP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:ELTRINGHAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:SLOSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:17917 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6384
Mailing Address - Country:US
Mailing Address - Phone:425-483-5594
Mailing Address - Fax:425-483-5594
Practice Address - Street 1:17917 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 201A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6384
Practice Address - Country:US
Practice Address - Phone:425-483-5594
Practice Address - Fax:425-483-5594
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist