Provider Demographics
NPI:1659129716
Name:CHRISTENSEN, KELLY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WIDOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-9228
Mailing Address - Country:US
Mailing Address - Phone:716-640-3565
Mailing Address - Fax:
Practice Address - Street 1:3670 COUNTY ROAD 6
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-9138
Practice Address - Country:US
Practice Address - Phone:315-789-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016940225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist