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NPI Code Detail

MEDICARE: DR. REBECCA JILL KELLY PH.D.

MEDICARE: DR. REBECCA JILL KELLY PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologistAU2490CA

General Provider Information

NPI Number : 1598942054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA JILL KELLY PH.D.
Provider Business Mailing Address
First Line : 1035 GRAYSON ST
Second Line :
City : BERKELEY
State : CA
Zip : 94710-2642
Country : US
Telephone Number : 510-848-4801
Fax Number :
Provider Business Practice Location Address
First Line : 1035 GRAYSON ST
Second Line :
City : BERKELEY
State : CA
Zip : 94710-2642
Country : US
Telephone Number : 510-848-4801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2008
Last Update Date : 01/28/2008

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Directions to “ DR. REBECCA JILL KELLY PH.D.” Practice Location

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