MEDICARE: STEPHEN E KELLY 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	225700000X	Massage Therapist	227.020378	IL

General Provider Information

NPI Number	:	1447117098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN E KELLY LMT

Provider Business Mailing Address
First Line	:	770 N LASALLE STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654
Country	:	US
Telephone Number	:	312-321-0004
Fax Number	:	312-379-9576

Provider Business Practice Location Address
First Line	:	770 N LASALLE STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654
Country	:	US
Telephone Number	:	312-321-0004
Fax Number	:	312-379-9576

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ STEPHEN E KELLY LMT” Practice Location

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