Provider Demographics
NPI:1710146378
Name:KELLY, CYNTHIA LOUISE (OTR)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:KELLY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LOUISE
Other - Last Name:AXELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:125 WINTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3321
Mailing Address - Country:US
Mailing Address - Phone:603-434-2322
Mailing Address - Fax:
Practice Address - Street 1:55 HARRIS RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2145
Practice Address - Country:US
Practice Address - Phone:603-888-1573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0845225X00000X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation