Provider Demographics
NPI:1942988324
Name:FLANAGAN, KERRY MAUREEN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MAUREEN
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44264 SHEHAWKEN TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6450
Mailing Address - Country:US
Mailing Address - Phone:757-784-7963
Mailing Address - Fax:
Practice Address - Street 1:2909 N 118TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3643
Practice Address - Country:US
Practice Address - Phone:402-509-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR495155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist