Individual
KELSEY LEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
725 SE MAIN ST, ROSEBURG, OR 97470-3982
(541) 514-8945
Mailing address
725 SE MAIN ST, ROSEBURG, OR 97470-3982
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT-21692
OR
Other
Enumeration date
01/20/2019
Last updated
01/20/2019
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