MEDICARE: MELISSA KELLEY LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	016773	NY

General Provider Information

NPI Number	:	1336491216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KELLEY LMT

Provider Business Mailing Address
First Line	:	408 W CHURCH ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2603
Country	:	US
Telephone Number	:	607-733-3373
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 W CHURCH ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2603
Country	:	US
Telephone Number	:	607-733-3373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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Directions to “ MELISSA KELLEY LMT” Practice Location

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