Provider Demographics
NPI:1033568878
Name:SWEET, KELLY (OTRS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SWEET
Suffix:
Gender:F
Credentials:OTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOUNTAIN ASH LN
Mailing Address - Street 2:183
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2533
Mailing Address - Country:US
Mailing Address - Phone:910-922-4552
Mailing Address - Fax:
Practice Address - Street 1:3 MOUNTAIN ASH LN
Practice Address - Street 2:183
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2533
Practice Address - Country:US
Practice Address - Phone:910-922-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist