Provider Demographics
NPI:1912070830
Name:KELLY, HELEN D (LMT)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:D
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:257 GOLD LEAF LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0733
Mailing Address - Country:US
Mailing Address - Phone:775-887-8890
Mailing Address - Fax:775-882-2044
Practice Address - Street 1:408 N ROOP ST
Practice Address - Street 2:SUITE B
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4739
Practice Address - Country:US
Practice Address - Phone:775-883-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT-178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNVMT-178OtherST BRD MASSAGE THERAPIST