Individual
SHARON A KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 430-4746
Mailing address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 430-4746
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
575-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
575-019
WISCONSIN LICENSE
WI
Enumeration date
10/09/2007
Last updated
10/09/2007
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