Provider Demographics
NPI:1467758276
Name:HUTCHINSON, KEREN SHULTZ (LMBT)
Entity Type:Individual
Prefix:MS
First Name:KEREN
Middle Name:SHULTZ
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 GRESHAM LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6914
Mailing Address - Country:US
Mailing Address - Phone:704-661-6417
Mailing Address - Fax:
Practice Address - Street 1:180 GRESHAM LN
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6914
Practice Address - Country:US
Practice Address - Phone:704-661-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist