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General NPI Number Information
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NPI Number | 1992668982
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Entity Type | Individual
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Provider Name | MARY MANDICO KEALEY
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 9 LEGION MEMORIAL DR
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City | CHINA
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State | ME
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Zip | 04358-5641
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Country | US
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Telephone | 727-385-7547
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Fax |
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Provider Business Mailing Address
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Address Line | 22 WILLETTE DR
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City | CHINA
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State | ME
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Zip | 04358-4036
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Country | US
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Telephone | 727-385-7547
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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 | MT8125
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License Number State | ME
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