Individual
KELLIE TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
376 FULTON ST, FARMINGDALE, NY 11735-3666
(631) 741-1242
Mailing address
376 FULTON ST, FARMINGDALE, NY 11735-3666
(516) 520-1330
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
029308
NY
Other
Enumeration date
11/06/2019
Last updated
07/24/2021
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