Healthcare Provider Details

I. General information

NPI: 1629463161
Provider Name (Legal Business Name): KELLY A. DONLEY & ASSOCIATES L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6239 WASHINGTON BLVD
INDIANAPOLIS IN
46220-1828
US

IV. Provider business mailing address

6239 WASHINGTON BLVD
INDIANAPOLIS IN
46220-1828
US

V. Phone/Fax

Practice location:
  • Phone: 224-515-9060
  • Fax: 317-280-7636
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31005435
License Number StateIN

VIII. Authorized Official

Name: KELLY DONLEY
Title or Position: FOUNDER, CEO
Credential:
Phone: 224-515-9060