Healthcare Provider Details

I. General information

NPI: 1114094778
Provider Name (Legal Business Name): DEBRA KELLNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WILLIAM ST
SPRINGFIELD MA
01105-2349
US

IV. Provider business mailing address

112 MOUNTAIN ST
ELLINGTON CT
06029-4308
US

V. Phone/Fax

Practice location:
  • Phone: 413-788-2171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: