Provider Demographics
NPI:1194086033
Name:KELLY, GINA D (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:D
Last Name:KELLY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 2ND ST SW
Mailing Address - Street 2:GENEROSE 3-410
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902
Mailing Address - Country:US
Mailing Address - Phone:507-255-5548
Mailing Address - Fax:
Practice Address - Street 1:1216 2ND ST SW
Practice Address - Street 2:GENEROSE 3-410
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902
Practice Address - Country:US
Practice Address - Phone:507-255-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty