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General NPI Number Information
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NPI Number | 1609245034
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Entity Type | Individual
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Provider Name | KELLIE VICTORIA KING L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 1800 WEST CUMMINGS AVENUE
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City | OPP
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State | AL
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Zip | 36467
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Country | US
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Telephone | 334-343-6325
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Fax |
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Provider Business Mailing Address
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Address Line | 601 DIXIE DR
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City | ENTERPRISE
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State | AL
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Zip | 36330-1405
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Country | US
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Telephone | 334-343-6325
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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 | 2926
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License Number State | AL
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