Provider Demographics
NPI:1952634271
Name:KELLEY, STEPHANIE CARTER (PT, MS, PHD, OCS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CARTER
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT, MS, PHD, OCS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KAY
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7710 OLENTANGY RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235
Mailing Address - Country:US
Mailing Address - Phone:614-841-3900
Mailing Address - Fax:614-841-3930
Practice Address - Street 1:7710 OLENTANGY RIVER ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235
Practice Address - Country:US
Practice Address - Phone:614-841-3900
Practice Address - Fax:614-841-3930
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist