Provider Demographics
NPI:1447086137
Name:KELLY, ASHLEY (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 HATCHER LN STE D
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6496
Mailing Address - Country:US
Mailing Address - Phone:931-266-0830
Mailing Address - Fax:931-342-8387
Practice Address - Street 1:101 HATCHER LN STE D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6496
Practice Address - Country:US
Practice Address - Phone:931-266-0830
Practice Address - Fax:931-342-8387
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN11467225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist