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General NPI Number Information
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NPI Number | 1437938990
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Entity Type | Individual
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Provider Name | EMILY C PUCKETT LMT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 638 US HIGHWAY 68 W
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City | BENTON
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State | KY
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Zip | 42025-7423
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Country | US
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Telephone | 270-527-4526
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 MAGNESS RD
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City | BENTON
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State | KY
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Zip | 42025-5562
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Country | US
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Telephone | 270-804-5634
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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 | 281905
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License Number State | KY
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