=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205790920
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNEDY LEE LMT, MMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2025
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7917 ESTHER DR
-----------------------------------------------------
City | OXON HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20745-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-423-0315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7917 ESTHER DR
-----------------------------------------------------
City | OXON HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20745-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-423-0315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT200001484
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | M06986
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 0019020529
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------