Provider Demographics
NPI:1730677279
Name:SEITCHIK, KELLY M (LMT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:SEITCHIK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:SEITCHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KELLY M CALLAHAN
Mailing Address - Street 1:7 POTTERS CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2673
Mailing Address - Country:US
Mailing Address - Phone:215-595-8524
Mailing Address - Fax:215-595-8524
Practice Address - Street 1:11 FRIENDS LN STE 101
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1885
Practice Address - Country:US
Practice Address - Phone:215-595-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG008596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMSG008596OtherSTATE MASSAGE THERPIST LICENSE NUMBER