Individual
KELLEY CROMBIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16857
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16857
LICENSE MASSAGE THERAPIST
OR
Enumeration date
02/20/2014
Last updated
02/20/2014
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