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General NPI Number Information
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NPI Number | 1497173744
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Entity Type | Individual
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Provider Name | KELLEY COULTER
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Gender | Male
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 17 LINDEN PL REAR COURTYARD
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City | RED BANK
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State | NJ
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Zip | 07701-1939
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Country | US
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Telephone | 732-970-6164
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Fax |
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Provider Business Mailing Address
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Address Line | 17 LINDEN PL REAR COURTYARD
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City | RED BANK
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State | NJ
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Zip | 07701-1939
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Country | US
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Telephone |
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Fax |
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HP0183100
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License Number State | NJ
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