Provider Demographics
NPI:1417110875
Name:AMPTMANN, KELLEY ANNE
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ANNE
Last Name:AMPTMANN
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 1:2253 OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-8929
Mailing Address - Country:US
Mailing Address - Phone:630-988-1331
Mailing Address - Fax:
Practice Address - Street 1:2253 OVERLAND RD
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-8929
Practice Address - Country:US
Practice Address - Phone:630-988-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist