Provider Demographics
NPI:1174391833
Name:PRESTIPINO, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PRESTIPINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MARYLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1700
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-467-1321
Practice Address - Street 1:2400 MARYLAND RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1700
Practice Address - Country:US
Practice Address - Phone:800-321-9999
Practice Address - Fax:267-467-1321
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer