Provider Demographics
NPI:1942840517
Name:KELLEHER, EILEEN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:KELLEHER
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 1:25 RICHMOND PL
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1642
Mailing Address - Country:US
Mailing Address - Phone:914-447-9575
Mailing Address - Fax:
Practice Address - Street 1:25 RICHMOND PL
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1642
Practice Address - Country:US
Practice Address - Phone:914-447-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007811225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA