Provider Demographics
NPI:1780656637
Name:FITZPATRICK, KELLY COLLEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:COLLEEN
Last Name:FITZPATRICK
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 1:10 PLOUGHED NECK RD
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1050
Mailing Address - Country:US
Mailing Address - Phone:508-888-9689
Mailing Address - Fax:
Practice Address - Street 1:10 PLOUGHED NECK RD
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1050
Practice Address - Country:US
Practice Address - Phone:508-888-9689
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4317225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics