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General NPI Number Information
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NPI Number | 1730531773
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Entity Type | Organization
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Legal Business Name | ESSENTIAL KNEADS, LLC
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 1212 HARRY BYRD HWY
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City | DARLINGTON
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State | SC
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Zip | 29532-3509
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Country | US
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Telephone | 843-267-6506
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Fax | 843-393-1107
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Provider Business Mailing Address
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Address Line | 1212 HARRY BYRD HWY
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City | DARLINGTON
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State | SC
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Zip | 29532-3509
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Country | US
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Telephone | 843-267-6506
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Fax | 843-393-1107
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Authorized Official
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Title or Position | OWNER, LICENSED MASSAGE THERAPIST
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Name | TAMARA SHERRILL KELLY
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Credential | LMT, MMP, NCTMB, A.A
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Telephone | 843-267-6506
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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 | MAS 1763
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License Number State | SC
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