Provider Demographics
NPI:1306933056
Name:KELLETT, MEREDITH ANN
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:KELLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:ANN
Other - Last Name:HODGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 FALMOUTH SANDWICH RD
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-1814
Mailing Address - Country:US
Mailing Address - Phone:508-968-6572
Mailing Address - Fax:508-968-6581
Practice Address - Street 1:5201 LEE RD
Practice Address - Street 2:
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02542-1313
Practice Address - Country:US
Practice Address - Phone:508-968-6572
Practice Address - Fax:508-968-6581
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other