Provider Demographics
NPI:1477706109
Name:ROBERTS, KELLY S (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:S
Last Name:ROBERTS
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:PO BOX 3142
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-0142
Mailing Address - Country:US
Mailing Address - Phone:518-542-0528
Mailing Address - Fax:
Practice Address - Street 1:25 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1222
Practice Address - Country:US
Practice Address - Phone:518-542-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-26
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010738225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics