Provider Demographics
NPI:1487469672
Name:KELLY, THOMAS PATRICK
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:KELLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 BRODIE BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7520
Mailing Address - Country:US
Mailing Address - Phone:440-994-0041
Mailing Address - Fax:
Practice Address - Street 1:8311 BRODIE BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7520
Practice Address - Country:US
Practice Address - Phone:440-994-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHJWM2444347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle