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NPI Code Detail

MEDICARE: CHRISTINA MARIE KELLY

MEDICARE: CHRISTINA MARIE KELLY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1700728896
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA MARIE KELLY
Provider Business Mailing Address
First Line : 996 ROYAL MARCO WAY
Second Line :
City : MARCO ISLAND
State : FL
Zip : 34145-1829
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5959 TOPANGA CANYON BLVD STE 125
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7598
Country : US
Telephone Number : 818-960-0633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ CHRISTINA MARIE KELLY ” Practice Location

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