Provider Demographics
NPI:1598202103
Name:KALIN, DENISE REGINA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:REGINA
Last Name:KALIN
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 1:642 WINTERCREEPER DR
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-9228
Mailing Address - Country:US
Mailing Address - Phone:301-399-9578
Mailing Address - Fax:
Practice Address - Street 1:1561 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-9226
Practice Address - Country:US
Practice Address - Phone:843-212-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-21
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC8229225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist