MEDICARE: KELLY JEAN LINDSAY

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	MT011363	TX

General Provider Information

NPI Number	:	1902208226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JEAN LINDSAY

Provider Business Mailing Address
First Line	:	452 FOREST SQ
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-4401
Country	:	US
Telephone Number	:	903-757-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	452 FOREST SQ
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-4401
Country	:	US
Telephone Number	:	903-757-3400
Fax Number	:

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

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/17/2014

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Directions to “ KELLY JEAN LINDSAY ” Practice Location

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