Provider Demographics
NPI:1720520307
Name:DICKSON, KELLY (CSCD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DICKSON
Suffix:
Gender:F
Credentials:CSCD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAINT FRANCIS WAY
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5119
Mailing Address - Country:US
Mailing Address - Phone:724-772-5350
Mailing Address - Fax:
Practice Address - Street 1:5 SAINT FRANCIS WAY
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-5119
Practice Address - Country:US
Practice Address - Phone:724-772-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014696225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist