Provider Demographics
NPI:1538575899
Name:KELLY, TORRINAL
Entity type:Individual
Prefix:MRS
First Name:TORRINAL
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 FM 1960 RD E
Mailing Address - Street 2:APT 704
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2278
Mailing Address - Country:US
Mailing Address - Phone:303-261-6682
Mailing Address - Fax:281-973-9611
Practice Address - Street 1:7850 FM 1960 RD E
Practice Address - Street 2:APT 704
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2278
Practice Address - Country:US
Practice Address - Phone:303-261-6682
Practice Address - Fax:281-973-9611
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO052210614172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver