Provider Demographics
NPI:1386393130
Name:KELLY, COURTNEY ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
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 1:830 PATRIOTS RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-1303
Mailing Address - Country:US
Mailing Address - Phone:978-895-9776
Mailing Address - Fax:
Practice Address - Street 1:307 INTERNATIONAL CIR STE 100
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1387
Practice Address - Country:US
Practice Address - Phone:410-667-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist