Provider Demographics
NPI:1376942698
Name:KENNELLY, NANCY (OTR/L)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KENNELLY
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 1:6948 BROOKS MILLER RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9554
Mailing Address - Country:US
Mailing Address - Phone:740-407-5850
Mailing Address - Fax:
Practice Address - Street 1:6948 BROOKS MILLER RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9554
Practice Address - Country:US
Practice Address - Phone:740-407-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-002108225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist