Provider Demographics
NPI:1093858532
Name:FAKO, KELLEY DAWN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:DAWN
Last Name:FAKO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:DAWN
Other - Last Name:GETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 OLD ROUTE 8 S
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059-2024
Mailing Address - Country:US
Mailing Address - Phone:724-898-1158
Mailing Address - Fax:
Practice Address - Street 1:144 OLD ROUTE 8 S
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:PA
Practice Address - Zip Code:16059-2024
Practice Address - Country:US
Practice Address - Phone:724-898-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0037072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer