Provider Demographics
NPI:1033407887
Name:GIAQUINTO, KELLY (MS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GIAQUINTO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2349
Mailing Address - Country:US
Mailing Address - Phone:781-275-0148
Mailing Address - Fax:
Practice Address - Street 1:489 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-2349
Practice Address - Country:US
Practice Address - Phone:781-275-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3125225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics