Healthcare Provider Details

I. General information

NPI: 1932408671
Provider Name (Legal Business Name): CAROLINE MARIE JEWETT KELLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CAROLINE MARIE JEWETT

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WASHINGTON RD
RYE NH
03870-2318
US

IV. Provider business mailing address

50 CREST DR
SOMERSWORTH NH
03878-4405
US

V. Phone/Fax

Practice location:
  • Phone: 603-964-8144
  • Fax:
Mailing address:
  • Phone: 603-692-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1002
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: