Provider Demographics
NPI:1073719878
Name:YELLOWHAIR-KELLY, MARION L (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:L
Last Name:YELLOWHAIR-KELLY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NW SAINT MARY DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2524
Mailing Address - Country:US
Mailing Address - Phone:816-220-3900
Mailing Address - Fax:816-220-0877
Practice Address - Street 1:801 NW SAINT MARY DR
Practice Address - Street 2:SUITE 220
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2524
Practice Address - Country:US
Practice Address - Phone:816-220-3900
Practice Address - Fax:816-220-0877
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266552Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER