Provider Demographics
NPI:1003004433
Name:KELLEY, CHAD R (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:R
Last Name:KELLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2325
Mailing Address - Country:US
Mailing Address - Phone:781-344-4000
Mailing Address - Fax:781-344-7040
Practice Address - Street 1:232 PEARL ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2325
Practice Address - Country:US
Practice Address - Phone:781-344-4000
Practice Address - Fax:781-344-7040
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer