Healthcare Provider Details

I. General information

NPI: 1275086449
Provider Name (Legal Business Name): KELLY ELIZABETH WINTER ORT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 VANDERBILT AVE
NORWOOD MA
02062-5011
US

IV. Provider business mailing address

101 VANDERBILT AVE
NORWOOD MA
02062-5011
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-0405
  • Fax:
Mailing address:
  • Phone: 781-551-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11985
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT01567
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: