| Doctor Name: | MRS. KELLY NICOLE EMERSON |
| NPI Number: | 1831484096 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.M.T, P.T.A |
| License Number: | 019962 |
| Business Practice Address: | 240 Red Tail Ste. 3 & 4 Orchard Park, NY - 141271581 |
| Business Phone Number: | 7166749600 |
| Business Fax Number: | 7166749700 |
| Mailing Address: | 240 Red Tail Dr., Ste. 3 & 4 ORCHARD PARK |
| State: | NY |
| Postal Code: | 14127 |
| Phone Number: | 7166749600 |
| Fax Number: | 7166749700 |
| NPI Enumeration Date: | 06/16/2011 |
| NPI Last Update Date: | 06/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 019962 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| 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. |