Provider Demographics
NPI:1619721362
Name:MELROY, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MELROY
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 1:1515 COUNTY ROAD 26
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:OH
Mailing Address - Zip Code:45843-9165
Mailing Address - Country:US
Mailing Address - Phone:567-295-1003
Mailing Address - Fax:
Practice Address - Street 1:1515 COUNTY ROAD 26
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:OH
Practice Address - Zip Code:45843-9165
Practice Address - Country:US
Practice Address - Phone:567-295-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSM346233172A00000X
174200000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals