Provider Demographics
NPI:1073723011
Name:MORRIS, KELLY CHRISTINE
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:CHRISTINE
Last Name:MORRIS
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 1:33 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1808
Mailing Address - Country:US
Mailing Address - Phone:937-301-9034
Mailing Address - Fax:
Practice Address - Street 1:324 PARK AVE
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1718
Practice Address - Country:US
Practice Address - Phone:937-301-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSM224148174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH256-8805OtherINDEPENDANT PROVIDER