Individual
KELCEE TOMCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
30544 HIGHWAY 200 STE 326, PONDERAY, ID 83852-5042
(208) 205-9559
Mailing address
408 CABINET VIEW LN, SANDPOINT, ID 83864-6751
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3787
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-3787
IDAHO MASSAGE LICENSE
ID
Enumeration date
05/10/2019
Last updated
06/11/2019
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