Provider Demographics
NPI:1679629596
Name:COUTURIER KALLEN, MARIE-CLOTILDE (LMT)
Entity Type:Individual
Prefix:
First Name:MARIE-CLOTILDE
Middle Name:
Last Name:COUTURIER KALLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CLOE
Other - Middle Name:
Other - Last Name:COUTURIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:11211 PROSPERITY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3446
Mailing Address - Country:US
Mailing Address - Phone:561-622-4706
Mailing Address - Fax:561-627-9231
Practice Address - Street 1:11211 PROSPERITY FARMS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3446
Practice Address - Country:US
Practice Address - Phone:561-622-4706
Practice Address - Fax:561-627-9231
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA24102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist