Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 9741 | MA |
Y | 225XG0600X | Occupational Therapist - Gerontology | 9741 | MA |
NPI | 1952607590 |
---|---|
Provider Name | Dara Rachel Kelly |
First Address | Greenfield, MA 01301-9625 |
Second Address | Springfield, MA 01108-2345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2011 |
Last Update Date | 30/01/2011 |