Basic Information
| Provider Information | |||||||||
| NPI: | 1083057822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KITCHENS | ||||||||
| FirstName: | ALIN | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 SE BARRINGTON DR | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982773200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662400808 | ||||||||
| FaxNumber: | 8662400808 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 STEWARD ROAD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604163322 | ||||||||
| FaxNumber: | 3604163302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2013 | ||||||||
| LastUpdateDate: | 02/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA60328543 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | 103K00000X | 01 | WA | L.E.A.P.S. AND BEYOND INC. | OTHER |