Doctor Name: | MRS. DIANE E KELLEY |
NPI Number: | 1285845453 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.M.T |
License Number: | 11532 |
Business Practice Address: | 6422 E Main St Suite 102 Reynoldsburg, OH - 430682358 |
Business Phone Number: | 6145619183 |
Business Fax Number: | 6143679281 |
Mailing Address: | 1054 Nocturne Rd E, REYNOLDSBURG |
State: | OH |
Postal Code: | 430682016 |
Phone Number: | 6145619183 |
Fax Number: | 6143679281 |
NPI Enumeration Date: | 05/26/2007 |
NPI Last Update Date: | 03/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 11532 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |