Healthcare Provider Details

I. General information

NPI: 1902303779
Provider Name (Legal Business Name): GRACE ANN KELLY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PENNSYLVANIA AVE SE BSMT
WASHINGTON DC
20003-3027
US

IV. Provider business mailing address

1301 PENNSYLVANIA AVE SE BSMT
WASHINGTON DC
20003-3027
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5439
  • Fax:
Mailing address:
  • Phone: 202-544-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT010001514
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119-008292
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number08437
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: