Provider Demographics
NPI:1598899122
Name:ALE, KELSEY M (LMT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:ALE
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 1:419 WILLIAMS ST APT B
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6382
Mailing Address - Country:US
Mailing Address - Phone:850-566-8496
Mailing Address - Fax:
Practice Address - Street 1:1535 KILLEARN CENTER BLVD
Practice Address - Street 2:A-5
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309
Practice Address - Country:US
Practice Address - Phone:850-566-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48963225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist