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General NPI Number Information
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NPI Number | 1558292003
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Entity Type | Individual
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Provider Name | KELLY ELIZABETH CORLEY
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Gender | Female
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Dates
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Enumeration Date | 05/26/2026
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Last Update Date | 05/26/2026
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Provider Practice Location Address
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Address Line | 730 MAIN ST # 230
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-3030
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Country | US
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Telephone | 813-763-5469
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Fax | 813-441-8362
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Provider Business Mailing Address
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Address Line | 4102 SEAVIEW ST APT 4
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-5100
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-26-536355
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License Number State | SC
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