Provider Demographics
NPI:1689963647
Name:KELLY L. RICE,
Entity Type:Organization
Organization Name:KELLY L. RICE,
Other - Org Name:SOVIA THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:717-379-4543
Mailing Address - Street 1:1015 TIVERTON RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-7699
Mailing Address - Country:US
Mailing Address - Phone:717-379-4543
Mailing Address - Fax:717-732-3740
Practice Address - Street 1:1015 TIVERTON RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-7699
Practice Address - Country:US
Practice Address - Phone:717-379-4543
Practice Address - Fax:717-732-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002751L252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019283190003OtherMEDICAL ASSISTANCE