Individual
KELLIE D CORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5843 ELLIOTT RD, LAKE CHARLES, LA 70605-0401
(337) 478-0834
Mailing address
5843 ELLIOTT RD, LAKE CHARLES, LA 70605-0401
(337) 478-0834
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LA0232-01
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA0232-01
MASSAGE THERAPY LICENSE
LA
Enumeration date
01/11/2007
Last updated
07/08/2007
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