Individual
MISS NICOLE MARIE KENNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
222 MANOR PL, GREENPORT, NY 11944-1261
(631) 268-4769
Mailing address
2595 VILLAGE LN, ORIENT, NY 11957-1469
(718) 683-1905
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
018013
NY
Other
Enumeration date
03/14/2015
Last updated
03/29/2021
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