MEDICARE: KATHLEEN KELLEY DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	2066PT	MT
2	332B00000X	Durable Medical Equipment & Medical Supplies	2066PT	MT

General Provider Information

NPI Number	:	1285961839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN KELLEY DPT

Provider Business Mailing Address
First Line	:	5767 FOX TRL
Second Line	:
City	:	FLORENCE
State	:	MT
Zip	:	59833-6661
Country	:	US
Telephone Number	:	406-240-3878
Fax Number	:	406-552-4843

Provider Business Practice Location Address
First Line	:	800 KENSINGTON AVE STE 100
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-5670
Country	:	US
Telephone Number	:	406-240-3878
Fax Number	:	406-552-4843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	02/27/2014

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