Provider Demographics
NPI:1043505308
Name:REILLY, KELLI ROBYN (LMP, CHP)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ROBYN
Last Name:REILLY
Suffix:
Gender:F
Credentials:LMP, CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 CORNWALL AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5023
Mailing Address - Country:US
Mailing Address - Phone:360-647-9187
Mailing Address - Fax:360-714-6119
Practice Address - Street 1:1229 CORNWALL AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5023
Practice Address - Country:US
Practice Address - Phone:360-647-9187
Practice Address - Fax:360-714-6119
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist