Provider Demographics
NPI:1871744672
Name:STUMP, KELLY MAE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MAE
Last Name:STUMP
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MANNERCHOR RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-9604
Mailing Address - Country:US
Mailing Address - Phone:610-921-2940
Mailing Address - Fax:
Practice Address - Street 1:120 TREXLER AVENUE
Practice Address - Street 2:KUTZTOWN MANOR
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530
Practice Address - Country:US
Practice Address - Phone:610-683-6220
Practice Address - Fax:610-683-6849
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist