Provider Demographics
NPI:1932408671
Name:KELLEY, CAROLINE MARIE JEWETT (PTA)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:MARIE JEWETT
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:MARIE
Other - Last Name:JEWETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 CREST DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-4405
Mailing Address - Country:US
Mailing Address - Phone:603-692-5616
Mailing Address - Fax:
Practice Address - Street 1:795 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NH
Practice Address - Zip Code:03870-2318
Practice Address - Country:US
Practice Address - Phone:603-964-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1002225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant