Healthcare Provider Details

I. General information

NPI: 1720107709
Provider Name (Legal Business Name): KELLIE SNYDER L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 ROUTE 145
EAST DURHAM NY
12423-1620
US

IV. Provider business mailing address

2355 ROUTE 145 P.O. BOX 70
EAST DURHAM NY
12423-1620
US

V. Phone/Fax

Practice location:
  • Phone: 518-634-2494
  • Fax: 518-634-2494
Mailing address:
  • Phone: 518-634-2494
  • Fax: 518-634-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number018583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: