Provider Demographics
NPI:1023634045
Name:ELECTROLYSIS BY KELLY INC
Entity type:Organization
Organization Name:ELECTROLYSIS BY KELLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRISY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-386-4663
Mailing Address - Street 1:715 LAKE ST STE 600
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1415
Mailing Address - Country:US
Mailing Address - Phone:708-386-4663
Mailing Address - Fax:
Practice Address - Street 1:715 LAKE ST STE 600
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1415
Practice Address - Country:US
Practice Address - Phone:708-386-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty