Provider Demographics
NPI:1336451178
Name:HAEHNEL, KELLIE L (RMT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:L
Last Name:HAEHNEL
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 OAKWOOD HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1937
Mailing Address - Country:US
Mailing Address - Phone:612-804-4463
Mailing Address - Fax:
Practice Address - Street 1:3435 WASHINGTON DR
Practice Address - Street 2:STE 206
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1339
Practice Address - Country:US
Practice Address - Phone:612-804-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist