Provider Demographics
NPI:1518789130
Name:KELLY, MEGHAN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9281 W 87TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-1244
Mailing Address - Country:US
Mailing Address - Phone:973-896-2205
Mailing Address - Fax:
Practice Address - Street 1:9281 W 87TH PL
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-1244
Practice Address - Country:US
Practice Address - Phone:973-896-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.000869225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist