Kelly Marie Connolly

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

License

2473045 Issued in IL

Practice address

10416 S Tripp Ave
Oak Lawn, IL 60453-4854

Phone

(708) 634-2703

NPI assigned

May 3, 2011

Last updated

May 3, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304380800000",
    "number": "1316239890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10416 S TRIPP AVE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534854",
            "telephone_number": "708-634-2703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10416 S TRIPP AVE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534854",
            "telephone_number": "708-634-2703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-03",
        "last_updated": "2011-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": "2473045",
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": "2427640",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Concord Nursing Home, Inc. (Concord Extended Care)
• Confident Communicators PLLC
• Grant Conklin, PHARMD
• Robert L Conner III, PT, MPT, CSCS, FAFS
• Alison Connolly, LCSW
• Gerald Phillip Connors, D.D.S.
• Consuelo, Inc. (Consuelo Therapeutic Services)
• Consultants in Radiation Oncology S.C.
• Stephen Francis Conte Jr.
• Johnny Contreras

• Developmental Therapist in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Developmental Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.