Provider Demographics
NPI:1154755718
Name:COSTELLO, KERRI (OTR/L)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
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 1:156 LOVERING STREET
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053
Mailing Address - Country:US
Mailing Address - Phone:508-533-6181
Mailing Address - Fax:
Practice Address - Street 1:4 SAMOSET AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2237
Practice Address - Country:US
Practice Address - Phone:508-208-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist