Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT4675 | ME |
NPI | 1003180126 |
---|---|
Provider Name | Richelle Lorinda Keefe |
First Address | Auburn, ME 04210-5299 |
Second Address | Auburn, ME 04210-5299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2012 |
Last Update Date | 07/03/2012 |