Individual
KELLY M CAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT, CMLDT
Contact information
Practice address
425 JOLIET ST STE 212, DYER, IN 46311-1766
(219) 381-9772
Mailing address
618 214TH ST, DYER, IN 46311-1508
(219) 381-9772
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT21505529
IN
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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