Individual
SUE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
123 STATE ROUTE 3, SUNBURY, OH 43074-6900
(740) 956-4301
(740) 965-5182
Mailing address
123 STATE ROUTE 3, SUNBURY, OH 43074-6900
(740) 956-4301
(740) 965-5182
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
33.005297
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1172068-0001
BUREAU OF WORKER'S COMPENSATION
OH
Enumeration date
01/22/2021
Last updated
01/22/2021
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