MEDICARE: KELLY HILLEY LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA76824	FL

General Provider Information

NPI Number	:	1144612045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY HILLEY LMT

Provider Business Mailing Address
First Line	:	256 MICHIGAN LN
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-6714
Country	:	US
Telephone Number	:	850-496-7306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1080 US HIGHWAY 331 S
Second Line	:	SUITE B
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-3374
Country	:	US
Telephone Number	:	850-892-4636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/02/2015

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