Provider Demographics
NPI:1730317694
Name:KELLY, LANIA D'AMORE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LANIA
Middle Name:D'AMORE
Last Name:KELLY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LANIA
Other - Middle Name:VIRGINIA
Other - Last Name:DAMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSOT
Mailing Address - Street 1:12 BORDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1102
Mailing Address - Country:US
Mailing Address - Phone:910-772-1373
Mailing Address - Fax:
Practice Address - Street 1:1007 PORTERS NECK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7383
Practice Address - Country:US
Practice Address - Phone:910-686-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist