Healthcare Provider Details

I. General information

NPI: 1114290723
Provider Name (Legal Business Name): TIFFANY L KELLETT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 STATE RD STE 102
ASHTABULA OH
44004-5904
US

IV. Provider business mailing address

3705 STATE RD STE 102
ASHTABULA OH
44004-5904
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-7670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013332
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: