Provider Demographics
NPI:1679775191
Name:SELLECK, KELLEY MARIE (MAC, LICAC)
Entity Type:Individual
Prefix:MISS
First Name:KELLEY
Middle Name:MARIE
Last Name:SELLECK
Suffix:
Gender:F
Credentials:MAC, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:359 MADISON ST
Mailing Address - Street 2:#2
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5559
Mailing Address - Country:US
Mailing Address - Phone:508-454-6770
Mailing Address - Fax:
Practice Address - Street 1:53 COUNTY RD
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1652
Practice Address - Country:US
Practice Address - Phone:508-758-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211399171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist