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General NPI Number Information
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NPI Number | 1285961839
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Entity Type | Individual
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Provider Name | KATHLEEN KELLEY DPT
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Gender | Female
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 800 KENSINGTON AVE STE 100
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City | MISSOULA
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State | MT
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Zip | 59801-5670
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Country | US
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Telephone | 406-240-3878
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Fax | 406-552-4843
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Provider Business Mailing Address
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Address Line | 5767 FOX TRL
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City | FLORENCE
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State | MT
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Zip | 59833-6661
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Country | US
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Telephone | 406-240-3878
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Fax | 406-552-4843
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2066PT
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2066PT
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License Number State | MT
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