Provider Demographics
NPI:1851850440
Name:KELLEY, KAREN LEE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:KELLEY
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 1:131 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2615
Mailing Address - Country:US
Mailing Address - Phone:716-848-6419
Mailing Address - Fax:716-848-6419
Practice Address - Street 1:131 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2615
Practice Address - Country:US
Practice Address - Phone:716-848-6419
Practice Address - Fax:716-848-6419
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist