MEDICARE: LIBBY KEMP

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	13694	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13694	OTHER	NC	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1386125672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIBBY KEMP

Provider Business Mailing Address
First Line	:	2006 S MAIN ST STE 206
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9391
Country	:	US
Telephone Number	:	919-570-6556
Fax Number	:	919-882-1141

Provider Business Practice Location Address
First Line	:	2006 S MAIN ST STE 206
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9391
Country	:	US
Telephone Number	:	919-570-6556
Fax Number	:	919-882-1141

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

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/24/2018

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Directions to “ LIBBY KEMP ” Practice Location

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