Provider Demographics
NPI:1710204615
Name:SONIA, KELLY KATHLEEN (COTA/L, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:KATHLEEN
Last Name:SONIA
Suffix:
Gender:F
Credentials:COTA/L, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1606
Mailing Address - Country:US
Mailing Address - Phone:978-290-1381
Mailing Address - Fax:
Practice Address - Street 1:535 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3720
Practice Address - Country:US
Practice Address - Phone:617-259-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9886225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist