Provider Demographics
NPI:1184748998
Name:MCDONALD, KELLY (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:MCDONALD
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 1:25 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-3114
Mailing Address - Country:US
Mailing Address - Phone:401-868-8877
Mailing Address - Fax:
Practice Address - Street 1:215 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1033
Practice Address - Country:US
Practice Address - Phone:401-432-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9092225X00000X, 225X00000X
MD5823225X00000X
TX111687225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist