Provider Demographics
NPI:1275870487
Name:BARTOCK, KELLY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:BARTOCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13402 TOWN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2673
Mailing Address - Country:US
Mailing Address - Phone:215-219-7354
Mailing Address - Fax:
Practice Address - Street 1:701 W SOMERDALE RD
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-2401
Practice Address - Country:US
Practice Address - Phone:856-504-3150
Practice Address - Fax:856-504-3157
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00583700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist