Provider Demographics
NPI:1205395514
Name:ALMEIDA, KELLY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ALMEIDA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1015
Mailing Address - Country:US
Mailing Address - Phone:508-644-1622
Mailing Address - Fax:
Practice Address - Street 1:65 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702-1015
Practice Address - Country:US
Practice Address - Phone:508-644-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9916OtherLICENSED MASSAGE THERAPIST