Provider Demographics
NPI:1396199113
Name:KELLY, MARGARET (OTR)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16583 COLUMBINE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7689
Mailing Address - Country:US
Mailing Address - Phone:303-349-1201
Mailing Address - Fax:
Practice Address - Street 1:16583 COLUMBINE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80602-7689
Practice Address - Country:US
Practice Address - Phone:303-349-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000636251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)