Provider Demographics
NPI:1154058915
Name:CONLY, MICHELLE KIMBERLY (RCEP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KIMBERLY
Last Name:CONLY
Suffix:
Gender:F
Credentials:RCEP
Other - Prefix:
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Mailing Address - Street 1:25234 TYRO AVE
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9550
Mailing Address - Country:US
Mailing Address - Phone:440-321-8555
Mailing Address - Fax:
Practice Address - Street 1:3311 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-222-7216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist