Healthcare Provider Details

I. General information

NPI: 1316250137
Provider Name (Legal Business Name): MARISSA E. KELLEY, OTR/L, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 CAMDEN RD
WARREN ME
04864-4124
US

IV. Provider business mailing address

3208 CAMDEN RD
WARREN ME
04864-4124
US

V. Phone/Fax

Practice location:
  • Phone: 207-594-5076
  • Fax: 207-594-7339
Mailing address:
  • Phone: 207-594-5076
  • Fax: 207-594-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT1342
License Number StateME

VIII. Authorized Official

Name: MARISSA KELLEY
Title or Position: OWNER
Credential: OTR/L
Phone: 207-594-5076