Provider Demographics
NPI:1255166294
Name:KELLY, AMANDA KAY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:KELLY
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 1:270 NARROW ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3006
Mailing Address - Country:US
Mailing Address - Phone:419-788-3169
Mailing Address - Fax:
Practice Address - Street 1:1199 DELAWARE AVE UNIT 110
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6475
Practice Address - Country:US
Practice Address - Phone:740-736-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator