Healthcare Provider Details

I. General information

NPI: 1386898385
Provider Name (Legal Business Name): KRISTEN LALIBERTE CASEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHMOND SQ SUITE 107K
PROVIDENCE RI
02906-5139
US

IV. Provider business mailing address

23 WOODBURY ST
WARWICK RI
02889-2621
US

V. Phone/Fax

Practice location:
  • Phone: 401-334-2285
  • Fax:
Mailing address:
  • Phone: 401-334-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number01555
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: