Provider Demographics
NPI:1437398898
Name:KELLEY, ZOE JANE (LMP)
Entity Type:Individual
Prefix:MS
First Name:ZOE
Middle Name:JANE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:ZOE
Other - Middle Name:J
Other - Last Name:BEEMAN-COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:5308 BALLARD AVE NW
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4006
Mailing Address - Country:US
Mailing Address - Phone:206-427-8578
Mailing Address - Fax:
Practice Address - Street 1:5308 BALLARD AVE NW
Practice Address - Street 2:SUITE 17
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4006
Practice Address - Country:US
Practice Address - Phone:206-427-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00007664225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist