Provider Demographics
NPI:1801053749
Name:KELM, AMELIA J
Entity type:Individual
Prefix:MISS
First Name:AMELIA
Middle Name:J
Last Name:KELM
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 1:1002 W CLARK ST
Mailing Address - Street 2:APT 312
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-7736
Mailing Address - Country:US
Mailing Address - Phone:815-603-0180
Mailing Address - Fax:
Practice Address - Street 1:401 W SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4716
Practice Address - Country:US
Practice Address - Phone:217-398-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor