Provider Demographics
NPI:1477803856
Name:RICHARDS, KELLY J (LMT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 HIGH STREET
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3739
Mailing Address - Country:US
Mailing Address - Phone:413-536-0142
Mailing Address - Fax:413-536-0607
Practice Address - Street 1:850 HIGH STREET
Practice Address - Street 2:SUITE 2B
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3739
Practice Address - Country:US
Practice Address - Phone:413-536-0142
Practice Address - Fax:413-536-0607
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist