Provider Demographics
NPI:1134886013
Name:CHACE, KELLY ANN (LMT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:CHACE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 NARROWS RD
Mailing Address - Street 2:
Mailing Address - City:CTR BARNSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03225-3124
Mailing Address - Country:US
Mailing Address - Phone:603-393-6602
Mailing Address - Fax:
Practice Address - Street 1:431 NARROWS RD
Practice Address - Street 2:
Practice Address - City:CTR BARNSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03225-3124
Practice Address - Country:US
Practice Address - Phone:603-393-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2832225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist