Provider Demographics
NPI:1780216630
Name:PELLI, KAITLYN AMBER COOK (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:AMBER COOK
Last Name:PELLI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 WALL ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1512
Mailing Address - Country:US
Mailing Address - Phone:609-921-1555
Mailing Address - Fax:
Practice Address - Street 1:219 WALL ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1512
Practice Address - Country:US
Practice Address - Phone:609-921-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-09
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00890400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist