Provider Demographics
NPI:1104961176
Name:RAYMOND, KERRY ANN (OT, CHT)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 INDIAN ROCK RD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1608
Mailing Address - Country:US
Mailing Address - Phone:603-952-4560
Mailing Address - Fax:603-952-4561
Practice Address - Street 1:32 INDIAN ROCK RD
Practice Address - Street 2:UNIT 4
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1608
Practice Address - Country:US
Practice Address - Phone:603-952-4560
Practice Address - Fax:603-952-4561
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0746225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH13Y003553NH04OtherANTHEM ID#