Healthcare Provider Details

I. General information

NPI: 1295996890
Provider Name (Legal Business Name): JULIE DANA KELCH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E RAMBLING CRK
TRYON NC
28782-2672
US

IV. Provider business mailing address

165 E RAMBLING CRK
TRYON NC
28782-2672
US

V. Phone/Fax

Practice location:
  • Phone: 407-902-5979
  • Fax:
Mailing address:
  • Phone: 407-902-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number9204
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: