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General NPI Number Information
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NPI Number | 1649795568
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Entity Type | Individual
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Provider Name | SIMONE D KELLY LMT
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Gender | Female
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 08/11/2017
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Provider Practice Location Address
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Address Line | 346 COREY AVE
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City | ST PETE BEACH
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State | FL
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Zip | 33706-1817
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Country | US
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Telephone | 631-445-5771
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Fax |
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Provider Business Mailing Address
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Address Line | 6580 SEMINOLE BLVD LOT 121
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City | SEMINOLE
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State | FL
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Zip | 33772-6315
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Country | US
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Telephone | 631-445-5571
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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 | MA77267
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License Number State | FL
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