Provider Demographics
NPI:1609915958
Name:GRAMKE, KELLY GRACE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:GRACE
Last Name:GRAMKE
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 1:10843 MCCASLAND RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-5652
Mailing Address - Country:US
Mailing Address - Phone:573-378-7140
Mailing Address - Fax:
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURIE
Practice Address - State:MO
Practice Address - Zip Code:65037-6173
Practice Address - Country:US
Practice Address - Phone:573-374-0767
Practice Address - Fax:573-374-1399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001002512174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist