Healthcare Provider Details

I. General information

NPI: 1821181561
Provider Name (Legal Business Name): RITA V KELLEHER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 JEFFREY'S NECK ROAD
IPSWICH MA
01938
US

IV. Provider business mailing address

64 WEST HODGES STREET
NORTON MA
02766
US

V. Phone/Fax

Practice location:
  • Phone: 978-356-4381
  • Fax:
Mailing address:
  • Phone: 508-622-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5187
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: