Individual
KAILEE CHAMPION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3449 REZANOF DRIVE EAST, KODIAK, AK 99615
(907) 486-2059
Mailing address
PO BOX 1451, KODIAK, AK 99615-1451
(907) 406-3153
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
102033
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102033
MASSAGE THERAPY LICENSE
AK
Enumeration date
03/23/2016
Last updated
03/23/2016
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