MEDICARE: KIMBERLY KAY JAMES MASSAGE THERAPIST

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	7501005068	MI

General Provider Information

NPI Number	:	1598281339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY KAY JAMES MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	204 E CHURCH ST
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-2953
Country	:	US
Telephone Number	:	517-264-6553
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 E CHURCH ST
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-2953
Country	:	US
Telephone Number	:	517-264-6553
Fax Number	:

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

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	07/21/2022

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