Healthcare Provider Details

I. General information

NPI: 1912070830
Provider Name (Legal Business Name): HELEN D KELLY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N ROOP ST SUITE B
CARSON CITY NV
89701-4739
US

IV. Provider business mailing address

257 GOLD LEAF LN
CARSON CITY NV
89706-0733
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-7002
  • Fax:
Mailing address:
  • Phone: 775-887-8890
  • Fax: 775-882-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT-178
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: