Individual
MRS. KELLY LYNN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6537 FAIRLANE DR, BOSTON, NY 14025-9637
(716) 226-7020
Mailing address
6537 FAIRLANE DR, BOSTON, NY 14025-9637
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
029564
NY
Other
Enumeration date
08/10/2017
Last updated
08/10/2017
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