Healthcare Provider Details

I. General information

NPI: 1275401168
Provider Name (Legal Business Name): KETTIA FENESTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 SOUTH RIVER ROAD MY SALON SUITE SUITE 104
BEDFORD NH
03110
US

IV. Provider business mailing address

79 SOUTH RIVER ROAD MY SALON SUITE SUITE 104
BEDFORD NH
03110
US

V. Phone/Fax

Practice location:
  • Phone: 347-770-0055
  • Fax:
Mailing address:
  • Phone: 347-770-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberED61JHDY3I
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberED61JHDY3I
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: