Provider Demographics
NPI:1215483904
Name:KELLEY, MAURA (CF-SLP)
Entity type:Individual
Prefix:MS
First Name:MAURA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 HEMMING WAY
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-9101
Mailing Address - Country:US
Mailing Address - Phone:610-762-5837
Mailing Address - Fax:
Practice Address - Street 1:1 S HOME AVE
Practice Address - Street 2:
Practice Address - City:TOPTON
Practice Address - State:PA
Practice Address - Zip Code:19562-1317
Practice Address - Country:US
Practice Address - Phone:610-682-1397
Practice Address - Fax:610-641-0170
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program