Healthcare Provider Details

I. General information

NPI: 1780401513
Provider Name (Legal Business Name): KALEY DANIELLE SNYDER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 MERCER ST
PRINCETON WV
24740-3111
US

IV. Provider business mailing address

114 MOUNTAIN VIEW DR
PRINCETON WV
24739-8925
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-2433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2024-4096
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: