Healthcare Provider Details

I. General information

NPI: 1285961839
Provider Name (Legal Business Name): KATHLEEN KELLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENSINGTON AVE STE 100
MISSOULA MT
59801-5670
US

IV. Provider business mailing address

5767 FOX TRL
FLORENCE MT
59833-6661
US

V. Phone/Fax

Practice location:
  • Phone: 406-240-3878
  • Fax: 406-552-4843
Mailing address:
  • Phone: 406-240-3878
  • Fax: 406-552-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2066PT
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2066PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: