Provider Demographics
NPI:1992029839
Name:CASEY, KELEN RAE GELLER (LMT)
Entity Type:Individual
Prefix:MS
First Name:KELEN
Middle Name:RAE GELLER
Last Name:CASEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:KELEN
Other - Middle Name:
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:65-1235A OPELO RD # 3
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8401
Mailing Address - Country:US
Mailing Address - Phone:808-885-8836
Mailing Address - Fax:808-443-0265
Practice Address - Street 1:65-1235A OPELO RD # 3
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8401
Practice Address - Country:US
Practice Address - Phone:808-885-8836
Practice Address - Fax:808-443-0265
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist