Provider Demographics
NPI:1538444245
Name:CARMICHAEL, KELLY LYNETTE (OT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNETTE
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5066 STATE ROUTE 19A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14550-9731
Mailing Address - Country:US
Mailing Address - Phone:585-493-5747
Mailing Address - Fax:
Practice Address - Street 1:5066 STATE ROUTE 19A
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14550-9731
Practice Address - Country:US
Practice Address - Phone:585-493-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011115-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist