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General NPI Number Information
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NPI Number | 1730207010
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Entity Type | Individual
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Provider Name | KELLEY CHARLES PTA
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8650 GOVERNORS HILL DR
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City | CINCINNATI
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State | OH
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Zip | 45249-1372
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Country | US
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Telephone | 513-791-5766
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Fax |
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Provider Business Mailing Address
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Address Line | 211 KENWOOD DR
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City | MIDDLETOWN
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State | OH
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Zip | 45042-3528
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Country | US
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Telephone | 513-423-9669
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5520
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License Number State | OH
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