Provider Demographics
NPI:1518600139
Name:KELLY, ANDREW (BOCPD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:BOCPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S COLORADO BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5937
Mailing Address - Country:US
Mailing Address - Phone:303-669-3771
Mailing Address - Fax:
Practice Address - Street 1:2425 S COLORADO BLVD STE 160
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5937
Practice Address - Country:US
Practice Address - Phone:303-669-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC50457224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist