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General NPI Number Information
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NPI Number | 1134653439
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Entity Type | Organization
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Legal Business Name | JOYCE KELLEY LMT
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 850 W IRONWOOD DR STE 104
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4903
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Country | US
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Telephone | 208-664-5225
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Fax | 208-664-5228
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Provider Business Mailing Address
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Address Line | 8109 N WAYNE BLVD
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City | HAYDEN
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State | ID
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Zip | 83835-5031
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Country | US
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Telephone | 208-664-5225
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Fax | 208-664-5228
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | JOYCE KELLEY
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Credential | LMT
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Telephone | 208-664-5225
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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 | MAS-1087
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License Number State | ID
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