MEDICARE: MRS. DENISE REGINA KALIN L.M.T.

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	SC8229	SC

General Provider Information

NPI Number	:	1598202103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE REGINA KALIN L.M.T.

Provider Business Mailing Address
First Line	:	642 WINTERCREEPER DR
Second Line	:
City	:	LONGS
State	:	SC
Zip	:	29568-9228
Country	:	US
Telephone Number	:	301-399-9578
Fax Number	:

Provider Business Practice Location Address
First Line	:	1561 HIGHWAY 17
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9226
Country	:	US
Telephone Number	:	843-212-2656
Fax Number	:

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

Provider Enumeration Date	:	01/21/2017
Last Update Date	:	01/21/2017

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