Provider Demographics
NPI:1053460295
Name:KELEHER, PATRICK ALAN (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ALAN
Last Name:KELEHER
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6617 RIO DE ONAR WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3411
Mailing Address - Country:US
Mailing Address - Phone:916-837-0508
Mailing Address - Fax:
Practice Address - Street 1:6617 RIO DE ONAR WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3411
Practice Address - Country:US
Practice Address - Phone:916-837-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist