Provider Demographics
NPI:1821181561
Name:KELLEHER, RITA V (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:V
Last Name:KELLEHER
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 1:64 WEST HODGES STREET
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766
Mailing Address - Country:US
Mailing Address - Phone:508-622-0187
Mailing Address - Fax:
Practice Address - Street 1:30 JEFFREY'S NECK ROAD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938
Practice Address - Country:US
Practice Address - Phone:978-356-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5187225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68552Medicare ID - Type Unspecified
MAP06226Medicare UPIN