MEDICARE: MRS. KELLY ANN HOOD LMT

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1689965386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY ANN HOOD LMT

Provider Business Mailing Address
First Line	:	960 LIBERTY ST SE
Second Line	:	SUITE 170
City	:	SALEM
State	:	OR
Zip	:	97302-4171
Country	:	US
Telephone Number	:	503-588-6633
Fax Number	:

Provider Business Practice Location Address
First Line	:	4356 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3914
Country	:	US
Telephone Number	:	503-689-1216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	06/13/2012

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