Provider Demographics
NPI:1144530122
Name:WENTWORTH, KELLYE ANN (OT/L)
Entity type:Individual
Prefix:
First Name:KELLYE
Middle Name:ANN
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04969-3235
Mailing Address - Country:US
Mailing Address - Phone:207-416-2327
Mailing Address - Fax:
Practice Address - Street 1:141 LEIGHTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-3718
Practice Address - Country:US
Practice Address - Phone:207-487-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METO2446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist