Provider Demographics
NPI:1962081711
Name:THOMAS, KELLY E
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SICKLERVILLE RD UNIT 144
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-8006
Mailing Address - Country:US
Mailing Address - Phone:856-264-5542
Mailing Address - Fax:
Practice Address - Street 1:902 VANDON LOOP
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9744
Practice Address - Country:US
Practice Address - Phone:856-264-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable