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General NPI Number Information
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NPI Number | 1487892550
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Entity Type | Individual
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Provider Name | KELLI LIN EAGER LMT
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Gender | Female
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 604 FAIRWAY VIEW DR
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City | BURLESON
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State | TX
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Zip | 76028-6382
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Country | US
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Telephone | 817-999-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 604 FAIRWAY VIEW DR
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City | BURLESON
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State | TX
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Zip | 76028-6382
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Country | US
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Telephone | 817-484-2318
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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 | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | MT011151
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MT011151
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License Number State | TX
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