Individual
KATHLEEN MARIE TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, LPN
Contact information
Practice address
2312 CRILL AVE, SUITE 1B, PALATKA, FL 32177-4828
(386) 546-3102
Mailing address
PO BOX 13, PALATKA, FL 32178-0013
(386) 546-3102
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA55691
FL
Other
Enumeration date
04/06/2010
Last updated
04/06/2010
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