Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MA40638 | FL |
NPI | 1003953597 |
---|---|
Provider Name | Ms. Kelly Marie Fernandez |
First Address | Miami, FL 33182-1171 |
Second Address | Miami, FL 33182-1171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |