Provider Demographics
NPI:1821281627
Name:MCDONALD, KELLEY LYNNE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:LYNNE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ROUTE 88 W
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:734-840-8100
Mailing Address - Fax:734-840-0559
Practice Address - Street 1:1608 ROUTE 88 W
Practice Address - Street 2:SUITE 112
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3009
Practice Address - Country:US
Practice Address - Phone:734-840-8100
Practice Address - Fax:734-840-0559
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00373100225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics