Individual
KELLY WALLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCP
Contact information
Practice address
12039 NE 128TH ST STE 140, KIRKLAND, WA 98034-3030
(425) 814-3258
Mailing address
12039 NE 128TH ST STE 140, KIRKLAND, WA 98034-3030
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
60816058
WA
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
60764098
WA
Other
Enumeration date
08/10/2017
Last updated
01/22/2020
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