Provider Demographics
NPI:1023578747
Name:CROSCO, KELI LYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KELI
Middle Name:LYN
Last Name:CROSCO
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 ALLEGHENY DR
Mailing Address - Street 2:
Mailing Address - City:MT LAKE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21550-3502
Mailing Address - Country:US
Mailing Address - Phone:304-698-9342
Mailing Address - Fax:
Practice Address - Street 1:706 E ALDER ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-3554
Practice Address - Country:US
Practice Address - Phone:301-334-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07959225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation