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Individual

THERESA KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
117 DERFUSS LN, BLAUVELT, NY 10913-1609
(845) 570-0771
Mailing address
117 DERFUSS LN, BLAUVELT, NY 10913-1609
(845) 570-0771

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
010932
NY
224Z00000X
Occupational Therapy Assistant
2162
CT
224Z00000X
Occupational Therapy Assistant
Primary
46TA09225300
NJ

Other

Enumeration date
04/07/2022
Last updated
04/07/2022
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