Provider Demographics
NPI:1326356296
Name:TREFETHERN-KELLEY, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:TREFETHERN-KELLEY
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 1:16 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:PEAKS ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04108-1124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 SCHOOL STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038
Practice Address - Country:US
Practice Address - Phone:207-222-1250
Practice Address - Fax:207-839-5018
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist