Healthcare Provider Details

I. General information

NPI: 1144905969
Provider Name (Legal Business Name): KELLIE MACELDOWNEY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BRIDGEWATER DR
MARLTON NJ
08053-4207
US

IV. Provider business mailing address

11 BRIDGEWATER DR
MARLTON NJ
08053-4207
US

V. Phone/Fax

Practice location:
  • Phone: 856-745-4591
  • Fax:
Mailing address:
  • Phone: 856-745-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberTR4600238300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License NumberTR4600238300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: