Provider Demographics
NPI:1447460571
Name:KELLEY, AMY CATHERINE (MS OT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CATHERINE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2200
Mailing Address - Country:US
Mailing Address - Phone:305-546-6438
Mailing Address - Fax:
Practice Address - Street 1:3335 N UNIVERSITY DR
Practice Address - Street 2:SUITE 5
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2200
Practice Address - Country:US
Practice Address - Phone:305-546-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007546225X00000X
FLOT9666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist