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NPI Code Detail

MEDICARE: MRS. LANIA D'AMORE KELLY OTR/L

MEDICARE: MRS. LANIA D'AMORE KELLY OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist4524NC

General Provider Information

NPI Number : 1730317694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LANIA D'AMORE KELLY OTR/L
Provider Business Mailing Address
First Line : 12 BORDEN AVE
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-1102
Country : US
Telephone Number : 910-772-1373
Fax Number :
Provider Business Practice Location Address
First Line : 1007 PORTERS NECK RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28411-7383
Country : US
Telephone Number : 910-686-6506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2009
Last Update Date : 06/30/2009

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