Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2913 | CO |
N | 225XG0600X | Occupational Therapist - Gerontology | 2913 | CO |
NPI | 1447725130 |
---|---|
Provider Name | Elise Marie Kelly |
First Address | Golden, CO 80401-4124 |
Second Address | Highlands Ranch, CO 80129-2440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2018 |
Last Update Date | 09/10/2018 |