Provider Demographics
NPI:1689965386
Name:HOOD, KELLY ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:HOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LIBERTY ST SE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4171
Mailing Address - Country:US
Mailing Address - Phone:503-588-6633
Mailing Address - Fax:
Practice Address - Street 1:4356 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3914
Practice Address - Country:US
Practice Address - Phone:503-689-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program