Kelly Gantt

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

05996 Issued in MD

Practice address

1110 Town Center Blvd
Odenton, MD 21113-1233

Phone

(410) 672-8094

NPI assigned

Jun 28, 2018

Last updated

Jun 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Physiotherapy Associates Inc

  • Rehabilitation Clinic/Center
  • Annapolis, MD
  • NPI 1639281157
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1245725522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 TOWN CENTER BLVD STE I",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 TOWN CENTER BLVD",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131233",
            "telephone_number": "410-672-8094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANTT",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-28",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "05996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Odenton",
            "affiliation": "N",
            "address_1": "1110 Town Center Blvd",
            "city": "Odenton",
            "state": "MD",
            "country_code": "US",
            "postal_code": "211131233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melissa Freymann
• Joseph Fritsch
• Clovis Kubia Fuh
• Karlie Fuller
• Lori Gallagher, LDN
• Katrina Nicole Garrison, LCPC
• Mark Gasbara, D.D.S.
• Geon Nam DMD LLC
• Jonathan J George
• Giant of Maryland LLC (Giant Pharmacy 2311)

• Occupational Therapist in Odenton, MD
• Providers in Odenton, MD by specialty
• Occupational Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.