Provider Demographics
NPI:1356492870
Name:KELLY, JOSEPH P (OTRLCHT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:KELLY
Suffix:
Gender:M
Credentials:OTRLCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S BROOKSIDE DR
Mailing Address - Street 2:BROOKSIDE ESTATES
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1192
Mailing Address - Country:US
Mailing Address - Phone:610-998-9308
Mailing Address - Fax:
Practice Address - Street 1:3411 SILVERSIDE RD
Practice Address - Street 2:CONCORD PLAZA SPRINGER BUILDING SUITE 105
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4812
Practice Address - Country:US
Practice Address - Phone:302-478-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0000408225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE239204ZBSXMedicare PIN
DEG00716Medicare PIN