Provider Demographics
NPI:1063225076
Name:MCDONALD, KELLY JANET (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JANET
Last Name:MCDONALD
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 1:110 HOPEWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1047
Mailing Address - Country:US
Mailing Address - Phone:484-244-5885
Mailing Address - Fax:484-652-2062
Practice Address - Street 1:110 HOPEWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-1047
Practice Address - Country:US
Practice Address - Phone:484-244-5885
Practice Address - Fax:484-652-2062
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC020444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist