Provider Demographics
NPI:1215204813
Name:CONLEY, KELLI (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 EMERSON VILLAGE PL APT 107
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-4038
Mailing Address - Country:US
Mailing Address - Phone:812-584-1608
Mailing Address - Fax:
Practice Address - Street 1:5220 EMERSON VILLAGE PL APT 107
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-4038
Practice Address - Country:US
Practice Address - Phone:812-584-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001835A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer