Provider Demographics
NPI:1679314496
Name:MOREL, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MOREL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 AUSTIN ST APT 24
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2464
Mailing Address - Country:US
Mailing Address - Phone:973-870-5412
Mailing Address - Fax:
Practice Address - Street 1:19 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6898
Practice Address - Country:US
Practice Address - Phone:508-690-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program