Provider Demographics
NPI:1427358589
Name:KIELY, JAMES L (MT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:KIELY
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1042
Mailing Address - Country:US
Mailing Address - Phone:774-200-4621
Mailing Address - Fax:
Practice Address - Street 1:24 OLD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1042
Practice Address - Country:US
Practice Address - Phone:774-200-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3323172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist