Provider Demographics
NPI:1457043747
Name:MARKLE, KELLIE A
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:A
Last Name:MARKLE
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 1:23 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-3916
Mailing Address - Country:US
Mailing Address - Phone:845-313-5221
Mailing Address - Fax:
Practice Address - Street 1:23 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-3916
Practice Address - Country:US
Practice Address - Phone:845-313-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child