Provider Demographics
NPI:1861627044
Name:GRIFFING, KELLY MARIE (MA OT/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:GRIFFING
Suffix:
Gender:F
Credentials:MA OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W WILLIAMS ST UNIT 346
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1998
Mailing Address - Country:US
Mailing Address - Phone:917-734-1822
Mailing Address - Fax:
Practice Address - Street 1:501 W WILLIAMS ST UNIT 346
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1998
Practice Address - Country:US
Practice Address - Phone:919-448-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014029-1252Y00000X
NC12449225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist