Healthcare Provider Details

I. General information

NPI: 1265442008
Provider Name (Legal Business Name): KELLY WEBER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 LIMERICK RD
ARUNDEL ME
04046-8158
US

IV. Provider business mailing address

39 LIMERICK RD
ARUNDEL ME
04046-8158
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-7861
  • Fax:
Mailing address:
  • Phone: 207-985-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT380
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: