Provider Demographics
NPI:1750407433
Name:KELLEY, JENNIFER EMILY (MSOTRL)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:EMILY
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PHILLIPS HILL RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-4841
Mailing Address - Country:US
Mailing Address - Phone:401-623-0124
Mailing Address - Fax:
Practice Address - Street 1:425 PHILLIPS HILL RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-4841
Practice Address - Country:US
Practice Address - Phone:401-385-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00357224Z00000X
RIOT01352225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist