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General NPI Number Information
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NPI Number | 1225335540
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Entity Type | Individual
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Provider Name | MARY KATHERINE REILLY OTR
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Gender | Female
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 1515 LAMBERTS MILL RD
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City | WESTFIELD
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State | NJ
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Zip | 07090-4763
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Country | US
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Telephone | 617-943-1163
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Fax |
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Provider Business Mailing Address
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Address Line | 524 DORIAN PL
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City | WESTFIELD
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State | NJ
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Zip | 07090-3337
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Country | US
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Telephone | 908-233-2186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 46TR005440400
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License Number State | NJ
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