Provider Demographics
NPI:1891091526
Name:KELLY, MEGAN MOYER (OT-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MOYER
Last Name:KELLY
Suffix:
Gender:F
Credentials:OT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WATERTOWN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2576
Mailing Address - Country:US
Mailing Address - Phone:617-923-4410
Mailing Address - Fax:617-923-0468
Practice Address - Street 1:74 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1147
Practice Address - Country:US
Practice Address - Phone:617-923-4410
Practice Address - Fax:617-923-0468
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226650225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist