Provider Demographics
NPI:1639216757
Name:MCDERMOTT, KELLY M (DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6916
Mailing Address - Country:US
Mailing Address - Phone:781-641-4168
Mailing Address - Fax:
Practice Address - Street 1:111 S BEDFORD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5145
Practice Address - Country:US
Practice Address - Phone:781-272-2100
Practice Address - Fax:781-272-0404
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8513251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health