Provider Demographics
NPI:1295996890
Name:KELCH, JULIE DANA (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:DANA
Last Name:KELCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E RAMBLING CRK
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-2672
Mailing Address - Country:US
Mailing Address - Phone:407-902-5979
Mailing Address - Fax:
Practice Address - Street 1:165 E RAMBLING CRK
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-2672
Practice Address - Country:US
Practice Address - Phone:407-902-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9204172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker