Provider Demographics
NPI:1508273400
Name:KELLEY, LINDA ROCHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ROCHELLE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2 WYNONA ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-6555
Mailing Address - Country:US
Mailing Address - Phone:479-739-5438
Mailing Address - Fax:
Practice Address - Street 1:2 WYNONA ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6555
Practice Address - Country:US
Practice Address - Phone:479-739-5438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3781225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant