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NPI Code Detail

MEDICARE: THERESA KELLEY

MEDICARE: THERESA KELLEY
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 : 1821914631
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA KELLEY
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1170
Country : US
Telephone Number : 855-324-0885
Fax Number :
Provider Business Practice Location Address
First Line : 4655 ROSEBUD LN
Second Line :
City : NEWBURGH
State : IN
Zip : 47630-9366
Country : US
Telephone Number : 812-213-8031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2026
Last Update Date : 06/25/2026

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Directions to “ THERESA KELLEY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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