Provider Demographics
NPI:1922754159
Name:FRICK, KELLY DANIELLE (MT-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DANIELLE
Last Name:FRICK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 CRANBERRY LN APT 1
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28626-9740
Mailing Address - Country:US
Mailing Address - Phone:336-314-5487
Mailing Address - Fax:
Practice Address - Street 1:373 CRANBERRY LN APT 1
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:NC
Practice Address - Zip Code:28626-9740
Practice Address - Country:US
Practice Address - Phone:336-314-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist