Provider Demographics
NPI:1033804778
Name:BLOOD, KELLY LEE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:BLOOD
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 1:13696 S TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:LINESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16424-8170
Mailing Address - Country:US
Mailing Address - Phone:814-573-4747
Mailing Address - Fax:
Practice Address - Street 1:13696 S TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:LINESVILLE
Practice Address - State:PA
Practice Address - Zip Code:16424-8170
Practice Address - Country:US
Practice Address - Phone:814-573-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency