Most Relevant Information
Provider Data
| NPI Number: | 1003292509 |
| Provider Name: | LISA KELLEY LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 175F00000X |
| Specialty: | Naturopath |
| License Number: | MT4261 |
Most Important Dates
| Enumeration Date: | 08/06/2015 |
| Last Updated: | 08/06/2015 |
Provider Practice Location
117 FREE STREET
C/O HEADGAMES SPA
PORTLAND
ME
04106
Practice Location Phone/Fax
| Phone: | 2072399485 |
| Fax: |
Provider Mailing Location
268 PREBLE ST
UNIT B
SOUTH PORTLAND
ME
041062232
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |