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NPI Code Detail

MEDICARE: MISS KRISTEN MICHELLE DEESE LMBT, MM

MEDICARE: MISS KRISTEN MICHELLE DEESE LMBT, MM
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
1225700000XMassage Therapist15037NC

General Provider Information

NPI Number : 1376091207
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KRISTEN MICHELLE DEESE LMBT, MM
Provider Business Mailing Address
First Line : 619 PRICE DAIRY RD
Second Line :
City : MONROE
State : NC
Zip : 28110-6984
Country : US
Telephone Number : 704-999-9930
Fax Number :
Provider Business Practice Location Address
First Line : 2325 HANOVER DR
Second Line :
City : MONROE
State : NC
Zip : 28110-0450
Country : US
Telephone Number : 704-282-4758
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2016
Last Update Date : 09/20/2016

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