Individual
MS. KELLY R MARACLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
890 ELMWOOD AVE, BUFFALO, NY 14222-1434
(716) 884-2826
Mailing address
13967 ROUTE 438, GOWANDA, NY 14070-9709
(716) 982-3967
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023019-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023019-1
NY STATE LICENSE NUMBER
NY
Enumeration date
03/25/2014
Last updated
04/07/2014
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