Provider Demographics
NPI:1669846507
Name:ROLING, KELLY MORRIS
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MORRIS
Last Name:ROLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:CHRISTINE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:822 FIR DR
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-9586
Mailing Address - Country:US
Mailing Address - Phone:908-303-7494
Mailing Address - Fax:
Practice Address - Street 1:701 SLATE BELT BLVD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-9341
Practice Address - Country:US
Practice Address - Phone:610-588-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist