Provider Demographics
NPI:1740853662
Name:KELLY, LINDA MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials: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 FOX DEN LN
Mailing Address - Street 2:
Mailing Address - City:STOCKHOLM
Mailing Address - State:NJ
Mailing Address - Zip Code:07460-1419
Mailing Address - Country:US
Mailing Address - Phone:973-229-8301
Mailing Address - Fax:
Practice Address - Street 1:5 FOX DEN LN
Practice Address - Street 2:
Practice Address - City:STOCKHOLM
Practice Address - State:NJ
Practice Address - Zip Code:07460-1419
Practice Address - Country:US
Practice Address - Phone:973-229-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00613500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00613500OtherNJ OCCUPATIONAL THERAPY LICENSE NUMBER