Provider Demographics
NPI:1861417826
Name:STALKER, KELLY ALISON (ATC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ALISON
Last Name:STALKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ALISON
Other - Last Name:DONOHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2 VICTORY WAY
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1342
Mailing Address - Country:US
Mailing Address - Phone:610-812-4333
Mailing Address - Fax:
Practice Address - Street 1:1145 KING RD
Practice Address - Street 2:
Practice Address - City:IMMACULATA
Practice Address - State:PA
Practice Address - Zip Code:19345-9903
Practice Address - Country:US
Practice Address - Phone:610-647-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART-002345-A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer