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General NPI Number Information
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NPI Number | 1801082862
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Entity Type | Individual
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Provider Name | KIM ELIZABETH BURNHAM-FECHNER L.M.T., L.V.T.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2007
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Last Update Date | 09/23/2007
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Provider Practice Location Address
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Address Line | 736 CENTER ST
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City | LEWISTON
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State | NY
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Zip | 14092-1706
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Country | US
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Telephone | 716-628-4636
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Fax |
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Provider Business Mailing Address
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Address Line | 736 CENTER ST
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City | LEWISTON
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State | NY
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Zip | 14092-1706
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Country | US
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Telephone | 716-628-4636
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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 | 019373
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License Number State | NY
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