Provider Demographics
NPI:1144520495
Name:KELLEY, MAUREEN ELIZABETH (LMP)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 56TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8240
Mailing Address - Country:US
Mailing Address - Phone:253-851-5138
Mailing Address - Fax:253-853-4972
Practice Address - Street 1:3715 56TH ST NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8240
Practice Address - Country:US
Practice Address - Phone:253-851-5138
Practice Address - Fax:253-853-4972
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60026348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist