Individual
KELLIE ANN STANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3465 BOX HILL CORPORATE CENTER DR, STE G, ABINGDON, MD 21009-1261
(410) 569-4806
(410) 568-5474
Mailing address
1812 MARSH RD, STORE 505, WILMINGTON, DE 19810-4581
(302) 793-0432
(302) 793-0400
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
05678
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214147
JOHNS HOPKINS
—
01
—
2191733361
CHAMPUS TRICARE
—
01
—
3316154000
IBC AMERIHEALTH
—
01
—
5070-0090
CARE FIRST
—
01
—
92838701
CARE FIRST
—
Enumeration date
10/01/2007
Last updated
12/05/2012
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