Individual
KELLY MARIE SEVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1061 109TH AVE NE STE D, BLAINE, MN 55434-3847
(612) 203-4835
Mailing address
1061 109TH AVE NE STE D, BLAINE, MN 55434-3847
(612) 203-4835
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
05/01/2010
Last updated
05/01/2010
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