MEDICARE: KELLY MCBAINE

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1881048718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MCBAINE

Provider Business Mailing Address
First Line	:	14221 JOEL CT
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-5108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14221 JOEL CT
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-5108
Country	:	US
Telephone Number	:	727-744-2870
Fax Number	:

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

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	04/18/2016

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