Provider Demographics
NPI:1053604033
Name:FOX, KIELEY MARIE (LMP)
Entity type:Individual
Prefix:MISS
First Name:KIELEY
Middle Name:MARIE
Last Name:FOX
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3017 E FRANCIS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-2435
Mailing Address - Country:US
Mailing Address - Phone:509-467-7991
Mailing Address - Fax:509-467-4834
Practice Address - Street 1:3017 E FRANCIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-2435
Practice Address - Country:US
Practice Address - Phone:509-467-7991
Practice Address - Fax:509-467-4834
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60064034225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist