Provider Demographics
NPI:1174216436
Name:COLLIER, KEANDRA NICOLE (LMT)
Entity type:Individual
Prefix:MS
First Name:KEANDRA
Middle Name:NICOLE
Last Name:COLLIER
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 1:11000 MERIDIAN HILL WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4073
Mailing Address - Country:US
Mailing Address - Phone:229-291-5207
Mailing Address - Fax:
Practice Address - Street 1:11000 MERIDIAN HILL WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4073
Practice Address - Country:US
Practice Address - Phone:229-291-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT200001272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty