Provider Demographics
NPI:1356795850
Name:VALDES, KELLEY (OTR)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:VALDES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 YUMA LN
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1225
Mailing Address - Country:US
Mailing Address - Phone:862-228-1751
Mailing Address - Fax:
Practice Address - Street 1:70 OVEROCKER RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2035
Practice Address - Country:US
Practice Address - Phone:845-485-9803
Practice Address - Fax:845-473-1270
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020442-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist