MEDICARE: CHRISTOPHER KELLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	006420	NY

General Provider Information

NPI Number	:	1538589486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER KELLY

Provider Business Mailing Address
First Line	:	10 TRAP ROCK CIR
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-6919
Country	:	US
Telephone Number	:	845-300-1057
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 TRAP ROCK CIR
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-6919
Country	:	US
Telephone Number	:	845-300-1057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/18/2014

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Directions to “ CHRISTOPHER KELLY ” Practice Location

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