Provider Demographics
NPI:1427154012
Name:KELLEY, CARLA JANE (PT)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:JANE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05150-9751
Mailing Address - Country:US
Mailing Address - Phone:802-886-2321
Mailing Address - Fax:802-886-2567
Practice Address - Street 1:43 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:NORTH SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05150-9751
Practice Address - Country:US
Practice Address - Phone:802-886-2321
Practice Address - Fax:802-886-2567
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002086208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y002456VT01OtherANTHEM BCNH
212100OtherCIGNA
VT43806OtherMOHAWK VALLEY PLAN
VT00005118OtherBCBS
VTVT975501OtherMEDICARE