Provider Demographics
NPI:1134429301
Name:ROBERTSON, KELLY LYNNE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNNE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAGLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1043
Mailing Address - Country:US
Mailing Address - Phone:207-288-5037
Mailing Address - Fax:
Practice Address - Street 1:11 EAGLE LAKE RD
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1043
Practice Address - Country:US
Practice Address - Phone:207-288-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1881225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics