Provider Demographics
NPI:1467632042
Name:RAFFERTY, JOAN KELLY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:KELLY
Last Name:RAFFERTY
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 1:31 LAKE ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3879
Mailing Address - Country:US
Mailing Address - Phone:978-632-4432
Mailing Address - Fax:978-632-6022
Practice Address - Street 1:31 LAKE ST
Practice Address - Street 2:SUITE 180
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3879
Practice Address - Country:US
Practice Address - Phone:978-632-4432
Practice Address - Fax:978-632-6022
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA913225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics