Provider Demographics
NPI:1891110987
Name:REDDING, KELLY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:REDDING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:REDDING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:1800 DAISY STREET EXT
Practice Address - Street 2:SUITE 360
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3254
Practice Address - Country:US
Practice Address - Phone:814-205-4043
Practice Address - Fax:814-205-4055
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008729225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396749Medicare PIN