Provider Demographics
NPI:1376367714
Name:O'MELIA, KELLEE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:MARIE
Last Name:O'MELIA
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 1:314 KIBBE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1311
Mailing Address - Country:US
Mailing Address - Phone:413-426-3782
Mailing Address - Fax:
Practice Address - Street 1:36 FIRETOWN RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-3401
Practice Address - Country:US
Practice Address - Phone:860-658-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004267225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist