Provider Demographics
NPI:1508598905
Name:WHITTAKER, KELSEY M (COTA/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 SMITHVILLE DR
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-9664
Mailing Address - Country:US
Mailing Address - Phone:732-674-8972
Mailing Address - Fax:
Practice Address - Street 1:7101 BAY FRONT DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3622
Practice Address - Country:US
Practice Address - Phone:410-268-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02989224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant