Healthcare Provider Details

I. General information

NPI: 1184748998
Provider Name (Legal Business Name): KELLY MCDONALD MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 WAMPANOAG TRL UNIT 3
RIVERSIDE RI
02915-1037
US

IV. Provider business mailing address

25 LYNN AVE
RUMFORD RI
02916-3114
US

V. Phone/Fax

Practice location:
  • Phone: 401-206-4030
  • Fax:
Mailing address:
  • Phone: 401-868-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9092
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT01160
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: