Provider Demographics
NPI:1730240094
Name:CANTRELL, KELLY L (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N ALSTON ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3510
Mailing Address - Country:US
Mailing Address - Phone:251-243-4200
Mailing Address - Fax:251-234-5757
Practice Address - Street 1:820 N ALSTON ST STE C
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3510
Practice Address - Country:US
Practice Address - Phone:251-243-4200
Practice Address - Fax:251-234-5757
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL000003816235Z00000X
OR11114235Z00000X
CASP9394235Z00000X
AL5214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist