Provider Demographics
NPI:1437534443
Name:KELLS, IAN THOMAS (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:THOMAS
Last Name:KELLS
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 WINCHELL AVE
Mailing Address - Street 2:APT 108
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2039
Mailing Address - Country:US
Mailing Address - Phone:630-930-0309
Mailing Address - Fax:
Practice Address - Street 1:3905 WINCHELL AVE
Practice Address - Street 2:APT 108
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2039
Practice Address - Country:US
Practice Address - Phone:630-930-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist