Individual
DIANE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
149 N MAIN ST, FAIRPORT, NY 14450-1434
(585) 377-2230
(585) 377-2312
Mailing address
149 N MAIN ST, FAIRPORT, NY 14450-1434
(585) 377-2230
(585) 377-2312
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
003625-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003625-1
—
NY
Enumeration date
07/31/2008
Last updated
07/31/2008
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