Provider Demographics
NPI:1104169838
Name:LACROIX, KELLY (LMT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:LACROIX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PLEASANT POND RD
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:ME
Mailing Address - Zip Code:04282-3327
Mailing Address - Country:US
Mailing Address - Phone:207-576-1529
Mailing Address - Fax:
Practice Address - Street 1:350 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4327
Practice Address - Country:US
Practice Address - Phone:207-576-1529
Practice Address - Fax:207-784-5160
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist