Provider Demographics
NPI:1952583676
Name:KELLEY, JOSPEH WILLIAM
Entity Type:Individual
Prefix:MR
First Name:JOSPEH
Middle Name:WILLIAM
Last Name:KELLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 W LINEBAUGH AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5095
Mailing Address - Country:US
Mailing Address - Phone:813-908-5302
Mailing Address - Fax:813-908-7013
Practice Address - Street 1:5008 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5095
Practice Address - Country:US
Practice Address - Phone:813-908-5302
Practice Address - Fax:813-908-7013
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032609700Medicaid
FL6237140001Medicare NSC