Provider Demographics
NPI:1487979258
Name:PELLETIER, KELLY JC (MA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JC
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MA
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Mailing Address - Street 1:145 FAUNCE CORNER RD STE K
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1263
Mailing Address - Country:US
Mailing Address - Phone:774-206-1125
Mailing Address - Fax:774-628-9657
Practice Address - Street 1:145 FAUNCE CORNER RD STE K
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1263
Practice Address - Country:US
Practice Address - Phone:774-206-1125
Practice Address - Fax:774-628-9657
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2012-07-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist