Provider Demographics
NPI:1336432939
Name:TAYLOR, KELLEY JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 LANESBORO RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:MA
Mailing Address - Zip Code:01225-9705
Mailing Address - Country:US
Mailing Address - Phone:413-743-0934
Mailing Address - Fax:
Practice Address - Street 1:265 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226-1614
Practice Address - Country:US
Practice Address - Phone:413-684-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3428225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant