Healthcare Provider Details

I. General information

NPI: 1205790920
Provider Name (Legal Business Name): KENNEDY LEE LMT, MMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7917 ESTHER DR
OXON HILL MD
20745-1421
US

IV. Provider business mailing address

7917 ESTHER DR
OXON HILL MD
20745-1421
US

V. Phone/Fax

Practice location:
  • Phone: 240-423-0315
  • Fax:
Mailing address:
  • Phone: 240-423-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT200001484
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM06986
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020529
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: