Provider Demographics
NPI:1700370293
Name:MARTELLO, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MARTELLO
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:N10994 SPRING CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-9718
Mailing Address - Country:US
Mailing Address - Phone:715-453-4741
Mailing Address - Fax:
Practice Address - Street 1:2100 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-3107
Practice Address - Country:US
Practice Address - Phone:715-453-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant