Individual
TIM RAY KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 NW HIGHWAY 101 STE A, LINCOLN CITY, OR 97367-3351
(442) 244-1336
Mailing address
1221 NW HIGHWAY 101 STE A, LINCOLN CITY, OR 97367-3351
(971) 727-5471
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000106995
OR
Other
Enumeration date
08/22/2022
Last updated
08/22/2022
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