Provider Demographics
NPI:1740315977
Name:NEOL, KELLY (ATC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:NEOL
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 1:30 BRADFORD CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03244-4864
Mailing Address - Country:US
Mailing Address - Phone:603-464-3504
Mailing Address - Fax:
Practice Address - Street 1:170 WARREN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2942
Practice Address - Country:US
Practice Address - Phone:603-225-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer