MEDICARE: MRS. KELLY BRETT

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	66125	CA

General Provider Information

NPI Number	:	1417637729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY BRETT

Provider Business Mailing Address
First Line	:	1083 RUBY CT
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2837
Country	:	US
Telephone Number	:	760-214-5016
Fax Number	:

Provider Business Practice Location Address
First Line	:	STE 300
Second Line	:	312 S CEDROS AVE
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1943
Country	:	US
Telephone Number	:	858-877-1574
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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