Provider Demographics
NPI:1366973356
Name:KIER, TYLER (LMP LICENSE)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:KIER
Suffix:
Gender:M
Credentials:LMP LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2291
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-2291
Mailing Address - Country:US
Mailing Address - Phone:360-943-6206
Mailing Address - Fax:360-943-6276
Practice Address - Street 1:1645 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5735
Practice Address - Country:US
Practice Address - Phone:360-943-6206
Practice Address - Fax:360-943-6276
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60496853225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist