Provider Demographics
NPI:1972070407
Name:MCHUGH, KELLY M
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:MCHUGH
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 1:3430 BURNET AVE # MLC4007
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2833
Mailing Address - Country:US
Mailing Address - Phone:503-803-8932
Mailing Address - Fax:513-636-7975
Practice Address - Street 1:3430 BURNET AVE # MLC4007
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2833
Practice Address - Country:US
Practice Address - Phone:503-803-8932
Practice Address - Fax:513-636-7975
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics