Provider Demographics
NPI:1437277878
Name:MARSH, KELLY DIANNE (OTR)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DIANNE
Last Name:MARSH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DIANNE
Other - Last Name:SCANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:9 TALL PINES LN
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9577
Mailing Address - Country:US
Mailing Address - Phone:207-283-6563
Mailing Address - Fax:
Practice Address - Street 1:79 CAT MOUSAM RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6924
Practice Address - Country:US
Practice Address - Phone:207-985-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist