Individual
MS. LISA J KELLIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1102 3RD ST, KAMIAH, ID 83536-5333
(208) 935-7702
(208) 935-1728
Mailing address
PO BOX 1508, KAMIAH, ID 83536-8500
(208) 935-7702
(280) 935-1728
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-05752
AZ
Other
Enumeration date
02/14/2011
Last updated
02/14/2011
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