MEDICARE: KELLYN DONOGHUE 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	7501017222	MI

General Provider Information

NPI Number	:	1629917315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLYN DONOGHUE LMT

Provider Business Mailing Address
First Line	:	1676 DEVONWOOD DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-3105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 LIVERNOIS RD STE 140
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-5000
Country	:	US
Telephone Number	:	248-264-3338
Fax Number	:

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

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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