Provider Demographics
NPI:1720241748
Name:JONES, KELLY ELIZABETH (MOT, OTR)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:JONES
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 TANGLEWILDE ST
Mailing Address - Street 2:330
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2100
Mailing Address - Country:US
Mailing Address - Phone:713-789-0472
Mailing Address - Fax:
Practice Address - Street 1:2500 TANGLEWILDE ST
Practice Address - Street 2:330
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2100
Practice Address - Country:US
Practice Address - Phone:713-789-0472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist