Provider Demographics
NPI:1639487291
Name:DURAN, KELLY (OTR)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 95TH ST
Mailing Address - Street 2:3F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7411
Mailing Address - Country:US
Mailing Address - Phone:718-921-0490
Mailing Address - Fax:
Practice Address - Street 1:423 95TH ST
Practice Address - Street 2:3F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7411
Practice Address - Country:US
Practice Address - Phone:718-921-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist