Provider Demographics
NPI:1043642242
Name:KELZ, TAMMY (MA34584)
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:
Last Name:KELZ
Suffix:
Gender:F
Credentials:MA34584
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11222
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34282
Mailing Address - Country:US
Mailing Address - Phone:941-753-7766
Mailing Address - Fax:
Practice Address - Street 1:810 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:941-753-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 34584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist