Provider Demographics
NPI:1144877283
Name:KESSEL, LENA FAY (LTM)
Entity type:Individual
Prefix:MS
First Name:LENA
Middle Name:FAY
Last Name:KESSEL
Suffix:
Gender:F
Credentials:LTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1811
Mailing Address - Country:US
Mailing Address - Phone:219-682-5918
Mailing Address - Fax:
Practice Address - Street 1:8081 RANDOLPH ST STE B
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-7068
Practice Address - Country:US
Practice Address - Phone:219-940-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20902401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist