Provider Demographics
NPI:1033509120
Name:KELLEY, ALISON JOY (LMT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:JOY
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14511 WESTLAKE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7783
Mailing Address - Country:US
Mailing Address - Phone:503-598-8099
Mailing Address - Fax:503-598-3980
Practice Address - Street 1:14511 WESTLAKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7783
Practice Address - Country:US
Practice Address - Phone:503-956-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20261225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist