Provider Demographics
NPI:1043473937
Name:KOEHLER, KELLEY MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:MICHELLE
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 RODEO RD STE C14
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6503
Mailing Address - Country:US
Mailing Address - Phone:505-474-4222
Mailing Address - Fax:
Practice Address - Street 1:2801 RODEO RD STE C14
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6503
Practice Address - Country:US
Practice Address - Phone:505-474-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3231225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist