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General NPI Number Information
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NPI Number | 1265226427
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Entity Type | Individual
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Provider Name | ELIZABETH CHRISTINE KELLEY CST-T, CMT
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Gender | Female
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 531 MARSH ST STE A
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3967
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Country | US
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Telephone | 805-674-1307
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Fax |
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Provider Business Mailing Address
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Address Line | 405 CALLISTO LN
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City | NIPOMO
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State | CA
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Zip | 93444-9656
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Country | US
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Telephone | 805-674-1307
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 31897
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License Number State | CA
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