Provider Demographics
NPI:1356120422
Name:FRIEDMAN, KELLI ROSE
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:ROSE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 WILLIAM LIVINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7696
Mailing Address - Country:US
Mailing Address - Phone:609-310-0699
Mailing Address - Fax:
Practice Address - Street 1:23 KILMER DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1563
Practice Address - Country:US
Practice Address - Phone:732-851-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01145200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist