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NPI Code Detail

MEDICARE: KRISTIN KELLY

MEDICARE: KRISTIN KELLY
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
1106S00000XBehavior TechnicianRBT-24-391405OH

General Provider Information

NPI Number : 1962359588
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN KELLY
Provider Business Mailing Address
First Line : 2733 E 12TH ST STE C2
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-4672
Country : US
Telephone Number : 248-846-8700
Fax Number : 248-846-8703
Provider Business Practice Location Address
First Line : 7580 NORTHCLIFF AVE
Second Line :
City : BROOKLYN
State : OH
Zip : 44144-3270
Country : US
Telephone Number : 248-846-8700
Fax Number : 248-846-8703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “ KRISTIN KELLY ” Practice Location

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