Provider Demographics
NPI:1518034867
Name:THOMASSET, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:THOMASSET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 HATHAWAY RD
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1916
Mailing Address - Country:US
Mailing Address - Phone:508-996-6763
Mailing Address - Fax:508-996-6764
Practice Address - Street 1:863 HATHAWAY RD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1916
Practice Address - Country:US
Practice Address - Phone:508-996-6763
Practice Address - Fax:508-996-6764
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA92096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist