Provider Demographics
NPI:1245756550
Name:JELLEY, CHARITY AILEEN (IECE)
Entity type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:AILEEN
Last Name:JELLEY
Suffix:
Gender:
Credentials:IECE
Other - Prefix:MS
Other - First Name:CHARITY
Other - Middle Name:A
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 RIVERS BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:45157-3400
Mailing Address - Country:US
Mailing Address - Phone:859-612-8642
Mailing Address - Fax:
Practice Address - Street 1:825 TIFFANIE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-4082
Practice Address - Country:US
Practice Address - Phone:859-475-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist