Provider Demographics
NPI:1437108396
Name:KELLEY, COLLEEN T (ATC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:T
Last Name:KELLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 YENSID DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-2601
Mailing Address - Country:US
Mailing Address - Phone:302-383-9882
Mailing Address - Fax:
Practice Address - Street 1:120 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1225
Practice Address - Country:US
Practice Address - Phone:302-376-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-0000251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist