Provider Demographics
NPI:1073178372
Name:KELLY D'AQUILLA, OT LLC
Entity Type:Organization
Organization Name:KELLY D'AQUILLA, OT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AQUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LOTR
Authorized Official - Phone:225-635-0149
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0276
Mailing Address - Country:US
Mailing Address - Phone:225-635-0149
Mailing Address - Fax:
Practice Address - Street 1:5637 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:ST. FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775
Practice Address - Country:US
Practice Address - Phone:225-978-7686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty