Provider Demographics
NPI:1437344140
Name:KELLEY, IRENE V (RPT)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:V
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARLBORO ROAD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833
Mailing Address - Country:US
Mailing Address - Phone:978-352-6693
Mailing Address - Fax:
Practice Address - Street 1:1 MARLBORO ROAD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833
Practice Address - Country:US
Practice Address - Phone:978-352-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist