Provider Demographics
NPI:1699134031
Name:ANDERSON, KYLEY (ATC)
Entity type:Individual
Prefix:
First Name:KYLEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KYLEY
Other - Middle Name:
Other - Last Name:MICKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:31 LONE EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-7378
Mailing Address - Country:US
Mailing Address - Phone:814-558-8977
Mailing Address - Fax:
Practice Address - Street 1:1502 E LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6660
Practice Address - Country:US
Practice Address - Phone:814-558-8977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-13
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer