Provider Demographics
NPI:1144761586
Name:KELLY, PAULA (MT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUNNYSIDE PARK
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3062
Mailing Address - Country:US
Mailing Address - Phone:781-662-4474
Mailing Address - Fax:
Practice Address - Street 1:9 SUNNYSIDE PARK
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3062
Practice Address - Country:US
Practice Address - Phone:781-662-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1467225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist