Provider Demographics
NPI:1053781849
Name:DENIS, KELLIE (CRT)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:
Last Name:DENIS
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9062 SW 34TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7972
Mailing Address - Country:US
Mailing Address - Phone:786-712-8118
Mailing Address - Fax:
Practice Address - Street 1:9062 SW 34TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7972
Practice Address - Country:US
Practice Address - Phone:786-712-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT14478246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other