Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kelly Jean Bault

Individual provider Developmental Therapist · NPI 1467749085

Kelly Jean Bault is a Developmental Therapist in Carbondale, Illinois. Practices as a sole proprietor. Registered with an NPI since 2011.

In the registry since
2011
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Practice location Address checks out

1800 Old West Main St Apt 204
Carbondale, IL 62901-2165
Phone: (815) 343-2776
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Developmental Therapist (primary) Taxonomy 222Q00000X

Record details

NPI number1467749085
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 3, 2011
Last updated in NPPESJuly 3, 2011

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