Individual
KELLI R SHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1700 E BOGARD RD STE A203, WASILLA, AK 99654-6569
(907) 406-8005
Mailing address
PO BOX 670437, CHUGIAK, AK 99567-0437
(907) 406-8005
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
101824
AK
225700000X
Massage Therapist
MA 60217495
WA
Other
Enumeration date
04/15/2011
Last updated
07/26/2019
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