Provider Demographics
NPI:1942078639
Name:SANTUCCI, KELSEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SANTUCCI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 TRENTON AVE N
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2354
Mailing Address - Country:US
Mailing Address - Phone:732-575-2303
Mailing Address - Fax:
Practice Address - Street 1:3349 HWY 138 EAST
Practice Address - Street 2:BUILDING B SUITE A
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-280-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01151100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist