Provider Demographics
NPI:1891014692
Name:PIERCE, KELLEY JEAN (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:JEAN
Last Name:PIERCE
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 1:107 VILLAGE ACRES DR.
Mailing Address - Street 2:APT 7
Mailing Address - City:EVANS CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16033
Mailing Address - Country:US
Mailing Address - Phone:724-355-5343
Mailing Address - Fax:
Practice Address - Street 1:107 VILLAGE ACRES DRIVE
Practice Address - Street 2:#7
Practice Address - City:EVANS CITY
Practice Address - State:PA
Practice Address - Zip Code:16033
Practice Address - Country:US
Practice Address - Phone:724-355-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006851224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant