Provider Demographics
NPI:1336426139
Name:DEMSKI, KELLY (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:DEMSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52926 RED FOX TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9247
Mailing Address - Country:US
Mailing Address - Phone:574-855-3153
Mailing Address - Fax:
Practice Address - Street 1:52926 RED FOX TRL
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9247
Practice Address - Country:US
Practice Address - Phone:574-855-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000734A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer