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General NPI Number Information
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NPI Number | 1356996011
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Entity Type | Individual
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Provider Name | ALLISON KELLY
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Gender | Female
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 4 INDUSTRIAL PARK DR SUITE B
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City | WALDORF
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State | MD
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Zip | 20602-2060
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Country | US
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Telephone | 240-925-4199
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Fax | 240-270-7256
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Provider Business Mailing Address
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Address Line | PO BOX 2373
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City | WALDORF
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State | MD
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Zip | 20604
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Country | US
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Telephone | 301-374-8895
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Fax | 240-270-7256
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | R5457
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License Number State | MD
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