Provider Demographics
NPI:1992857775
Name:ANDERSON, KELLI CHRISTINA (OTR/L; CHT)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:CHRISTINA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR/L; CHT
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:CHRISTINA
Other - Last Name:SKEELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L; CHT
Mailing Address - Street 1:99 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3012
Mailing Address - Country:US
Mailing Address - Phone:201-497-6211
Mailing Address - Fax:201-497-6212
Practice Address - Street 1:99 KINDERKAMACK RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3012
Practice Address - Country:US
Practice Address - Phone:201-497-6211
Practice Address - Fax:201-497-6212
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00093500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098345W54Medicare PIN