Individual
KELLI MARIE E BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2362 N OLD MILL LOOP, COEUR D ALENE, ID 83814-4954
(208) 292-7870
Mailing address
2362 N OLD MILL LOOP, COEUR D ALENE, ID 83814-4954
(208) 292-7870
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3429
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-3429
STATE LICENSURE
ID
Enumeration date
11/28/2022
Last updated
11/28/2022
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