Provider Demographics
NPI:1114290723
Name:KELLETT, TIFFANY L (DPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:KELLETT
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1914
Mailing Address - Country:US
Mailing Address - Phone:330-259-8006
Mailing Address - Fax:
Practice Address - Street 1:60 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1914
Practice Address - Country:US
Practice Address - Phone:330-259-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist