Provider Demographics
NPI:1104608488
Name:KELLEY, JOAN LOUISE (RRT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:LOUISE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 HACKETT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8502
Mailing Address - Country:US
Mailing Address - Phone:603-668-8161
Mailing Address - Fax:
Practice Address - Street 1:191 HACKETT HILL RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-8502
Practice Address - Country:US
Practice Address - Phone:603-668-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered