Provider Demographics
NPI:1285103853
Name:KELLY, DANIELLE LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNN
Last Name:KELLY
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 1:8629 W PAULING RD
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-9076
Mailing Address - Country:US
Mailing Address - Phone:708-289-9558
Mailing Address - Fax:
Practice Address - Street 1:8629 W PAULING RD
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449-9076
Practice Address - Country:US
Practice Address - Phone:708-289-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist