Individual
KELLY M LIENEKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6300 N WICKHAM RD STE 116, MELBOURNE, FL 32940-2023
(321) 757-6899
(321) 757-6859
Mailing address
3206 S HOPKINS AVE # 19, TITUSVILLE, FL 32780-5667
(321) 757-6899
(321) 757-6859
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA55378
FL
Other
Enumeration date
02/20/2012
Last updated
02/20/2012
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