Provider Demographics
NPI:1568612570
Name:GIFALDI, KELLY JO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:GIFALDI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:SZKLANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:326 E STATE ST
Mailing Address - Street 2:APT 2
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-1408
Mailing Address - Country:US
Mailing Address - Phone:585-766-2977
Mailing Address - Fax:
Practice Address - Street 1:326 E STATE ST
Practice Address - Street 2:APT 2
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1408
Practice Address - Country:US
Practice Address - Phone:585-766-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012506-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist