Provider Demographics
NPI:1528826971
Name:KERR, ELIAS AARON (OTR-L)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:AARON
Last Name:KERR
Suffix:
Gender:M
Credentials: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:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-0241
Mailing Address - Country:US
Mailing Address - Phone:570-336-0309
Mailing Address - Fax:272-207-2774
Practice Address - Street 1:311 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1620
Practice Address - Country:US
Practice Address - Phone:570-336-0309
Practice Address - Fax:272-207-2774
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019806225X00000X
PAOC010018225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist