Provider Demographics
NPI:1427023951
Name:PELOQUIN, KELLEY ANNE (ATC/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ANNE
Last Name:PELOQUIN
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2110
Mailing Address - Country:US
Mailing Address - Phone:267-429-0141
Mailing Address - Fax:
Practice Address - Street 1:1100 FOLLY RD
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-1421
Practice Address - Country:US
Practice Address - Phone:267-893-3171
Practice Address - Fax:267-893-3190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer