Healthcare Provider Details

I. General information

NPI: 1447636436
Provider Name (Legal Business Name): MARGARET KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FAIRWAY DR SUITE 100
DEERFIELD BEACH FL
33441-1811
US

IV. Provider business mailing address

600 FAIRWAY DR SUITE 100
DEERFIELD BEACH FL
33441-1811
US

V. Phone/Fax

Practice location:
  • Phone: 954-354-3738
  • Fax: 954-354-0171
Mailing address:
  • Phone: 954-354-3738
  • Fax: 954-354-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS3295
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: