Individual
KELLI L PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
11 DEPOT AVE, EMINENCE, KY 40019-1157
(502) 663-4401
Mailing address
76 QUAIL HOLLOW RD, EMINENCE, KY 40019-1247
(502) 663-4401
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
107811
KY
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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