Provider Demographics
NPI:1942471560
Name:HIMMELREICH, KELLI A (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KELLI
Middle Name:A
Last Name:HIMMELREICH
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 1:249 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9600
Mailing Address - Country:US
Mailing Address - Phone:973-579-4242
Mailing Address - Fax:973-383-8372
Practice Address - Street 1:249 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9600
Practice Address - Country:US
Practice Address - Phone:973-579-4242
Practice Address - Fax:973-383-8372
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00452900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist