Individual
MICHELLE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 731-4101
Mailing address
N9160 CEDAR HOLLOW CT, APPLETON, WI 54915-7078
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
68-019
WI
Other
Enumeration date
09/24/2007
Last updated
09/24/2007
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