Provider Demographics
NPI:1649300336
Name:KELLY, CHRISTINE M (MS, AT,C)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3852
Mailing Address - Country:US
Mailing Address - Phone:406-269-8290
Mailing Address - Fax:406-761-0070
Practice Address - Street 1:1914 1ST AVE. S.
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-590-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer