Provider Demographics
NPI:1790948651
Name:SIBLEY-GILL, KELLI SUSAN (COTA L)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:SUSAN
Last Name:SIBLEY-GILL
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1822
Mailing Address - Country:US
Mailing Address - Phone:484-226-7534
Mailing Address - Fax:610-625-4015
Practice Address - Street 1:634 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6362
Practice Address - Country:US
Practice Address - Phone:610-625-4885
Practice Address - Fax:610-625-4015
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA00P002523L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant