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General NPI Number Information
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NPI Number | 1104013549
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Entity Type | Individual
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Provider Name | KELLIE ANN STANLEY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 3465 BOX HILL CORPORATE CENTER DR STE G
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City | ABINGDON
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State | MD
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Zip | 21009-1261
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Country | US
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Telephone | 410-569-4806
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Fax | 410-568-5474
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Provider Business Mailing Address
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Address Line | 1812 MARSH RD STORE 505
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City | WILMINGTON
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State | DE
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Zip | 19810-4581
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Country | US
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Telephone | 302-793-0432
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Fax | 302-793-0400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 05678
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License Number State | MD
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