Provider Demographics
NPI:1043782006
Name:O'CONNOR, KELLY MARIE (DACM, MSTOM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DACM, MSTOM
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:O'CONNOR-RAMIREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DACM
Mailing Address - Street 1:32 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2637
Mailing Address - Country:US
Mailing Address - Phone:413-374-9248
Mailing Address - Fax:
Practice Address - Street 1:200 SILVER ST UNIT 105
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-3067
Practice Address - Country:US
Practice Address - Phone:413-612-4360
Practice Address - Fax:413-261-6242
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA279206171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist