Healthcare Provider Details

I. General information

NPI: 1780214817
Provider Name (Legal Business Name): KELLY ZHOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SW BLUE PKWY
LEES SUMMIT MO
64063-3965
US

IV. Provider business mailing address

306 SW BLUE PKWY
LEES SUMMIT MO
64063-3965
US

V. Phone/Fax

Practice location:
  • Phone: 816-600-5304
  • Fax:
Mailing address:
  • Phone: 816-600-5304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2017015929
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: