Provider Demographics
NPI:1295943827
Name:MORRISON, KELLY ANN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DOWNING RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2702
Mailing Address - Country:US
Mailing Address - Phone:617-966-4156
Mailing Address - Fax:
Practice Address - Street 1:777 DEDHAM ST
Practice Address - Street 2:MOUNT IDA COLLEGE
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3323
Practice Address - Country:US
Practice Address - Phone:617-928-7212
Practice Address - Fax:617-928-4036
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer