Provider Demographics
NPI:1912201609
Name:PARISH, KELLY ANN (LAC, LMT)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:ANN
Last Name:PARISH
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3105
Mailing Address - Country:US
Mailing Address - Phone:631-619-0369
Mailing Address - Fax:
Practice Address - Street 1:235 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3105
Practice Address - Country:US
Practice Address - Phone:631-619-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19068225700000X
NY4525171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist