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General NPI Number Information
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NPI Number | 1093187635
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Entity Type | Individual
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Provider Name | TINA KECK
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Gender | Female
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 70 N MAIN ST
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City | ADAMS
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State | NY
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Zip | 13605-3102
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Country | US
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Telephone | 315-405-1839
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Fax |
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Provider Business Mailing Address
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Address Line | 13443 BISHOP STREET RD
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City | ADAMS
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State | NY
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Zip | 13605-2171
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Country | US
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Telephone | 315-405-1839
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 025893-1
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License Number State | NY
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