Provider Demographics
NPI:1093914186
Name:MULCAHY, KEELY LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:LYNN
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 JULIET DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8455
Mailing Address - Country:US
Mailing Address - Phone:317-272-3578
Mailing Address - Fax:
Practice Address - Street 1:6808 JULIET DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8455
Practice Address - Country:US
Practice Address - Phone:317-272-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8893225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist