Provider Demographics
NPI:1639717754
Name:KELLY, ASHLEY R (CPO, LPO, LO)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:KELLY
Suffix:
Gender:F
Credentials:CPO, LPO, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3264
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815-3264
Mailing Address - Country:US
Mailing Address - Phone:423-318-8824
Mailing Address - Fax:423-318-2872
Practice Address - Street 1:1044 S CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-5235
Practice Address - Country:US
Practice Address - Phone:423-318-8824
Practice Address - Fax:423-318-2872
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT0000000047222Z00000X
TNPRO0000000037224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist