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NPI Code Detail

MEDICARE: KELLEY ALEXANDRIA TISION CLVT, COMS

MEDICARE: KELLEY ALEXANDRIA TISION CLVT, COMS
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
12255R0406XBlind Rehabilitation Specialist/Technologist

General Provider Information

NPI Number : 1760120349
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEY ALEXANDRIA TISION CLVT, COMS
Provider Business Mailing Address
First Line : 850 CAPITAL WALK DR APT 8306
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32303-0611
Country : US
Telephone Number : 340-244-3344
Fax Number :
Provider Business Practice Location Address
First Line : 2181 ORANGE AVE E
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32311-6144
Country : US
Telephone Number : 850-513-7623
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2022
Last Update Date : 05/24/2022

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