Healthcare Provider Details

I. General information

NPI: 1396651535
Provider Name (Legal Business Name): DR. KAELYN MILLS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 HOLLAND ST
SOMERVILLE MA
02144-2432
US

IV. Provider business mailing address

204 WASHINGTON ST APT 1
SOMERVILLE MA
02143-3144
US

V. Phone/Fax

Practice location:
  • Phone: 617-764-1997
  • Fax:
Mailing address:
  • Phone: 813-951-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: