Provider Demographics
NPI:1710341292
Name:GRILLO, KEELEY (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KEELEY
Middle Name:
Last Name:GRILLO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BEAVER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04222-5491
Mailing Address - Country:US
Mailing Address - Phone:413-313-2744
Mailing Address - Fax:
Practice Address - Street 1:368 MINOT AVE STE 3
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4331
Practice Address - Country:US
Practice Address - Phone:207-333-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12224225X00000X
CT4757225XP0200X
ME3369225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist