Individual
KELLIE L. FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT,LMT
Contact information
Practice address
626 E MAIN ST # 2, FARMINGTON, NM 87401-2714
(505) 608-9908
Mailing address
626 E MAIN ST # 2, FARMINGTON, NM 87401-2714
(505) 608-9908
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
5427
NM
Other
Enumeration date
12/16/2008
Last updated
12/16/2008
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