Provider Demographics
NPI:1295588721
Name:WERDER, KAELEE (CMT)
Entity type:Individual
Prefix:
First Name:KAELEE
Middle Name:
Last Name:WERDER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 BROADWAY ST STE 125
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3013
Mailing Address - Country:US
Mailing Address - Phone:320-763-0313
Mailing Address - Fax:320-763-4635
Practice Address - Street 1:1405 BROADWAY ST STE 125
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3013
Practice Address - Country:US
Practice Address - Phone:320-763-0313
Practice Address - Fax:320-763-4635
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist