Provider Demographics
NPI:1205613924
Name:MADAY, KELLY O'MEARA (OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:O'MEARA
Last Name:MADAY
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 1:350 S JACKSON ST APT 438
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3361
Mailing Address - Country:US
Mailing Address - Phone:847-565-9131
Mailing Address - Fax:
Practice Address - Street 1:350 S JACKSON ST APT 438
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3361
Practice Address - Country:US
Practice Address - Phone:847-565-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist