Provider Demographics
NPI:1700162872
Name:ANZALDI, KELLY (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ANZALDI
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 1:20881 STATE HWY 198
Mailing Address - Street 2:
Mailing Address - City:SAEGERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16433-6159
Mailing Address - Country:US
Mailing Address - Phone:814-763-2445
Mailing Address - Fax:
Practice Address - Street 1:20881 STATE HWY 198
Practice Address - Street 2:
Practice Address - City:SAEGERTOWN
Practice Address - State:PA
Practice Address - Zip Code:16433-6159
Practice Address - Country:US
Practice Address - Phone:814-763-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist