Healthcare Provider Details

I. General information

NPI: 1669246278
Provider Name (Legal Business Name): KELLIE A CAMPBELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MAIN ST
DEXTER ME
04930-1375
US

IV. Provider business mailing address

23 COOLEY RD
HARMONY ME
04942-7615
US

V. Phone/Fax

Practice location:
  • Phone: 207-717-0173
  • Fax:
Mailing address:
  • Phone: 207-717-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT6055
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: