Provider Demographics
NPI:1942878434
Name:PEPPERS, KELLEY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:PEPPERS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:PEPPERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KINETIC THERAPIES
Mailing Address - Street 1:45-119 KA HANAHOU CIR
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3008
Mailing Address - Country:US
Mailing Address - Phone:808-398-3153
Mailing Address - Fax:
Practice Address - Street 1:45-119 KA HANAHOU CIR
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3008
Practice Address - Country:US
Practice Address - Phone:808-398-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-13390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist