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Contact Information

KELLY R FOGARTY, COTA
2125 W NEW HAVEN AVE
MELBOURNE, FL32904-3803
 Phone: 321-729-4333
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapy Assistant

224Z00000X
 

Environmental Modification

224ZE0001X
Indicates primary specialty

NPI Profile & details for KELLY R FOGARTY · (Female)

NPI # 1518608082
Status Active
Credentials COTA (Certified Occupational Therapy Assistant)
Entity Individual
Enumeration date 04/06/2022
Last updated 04/06/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • FL License # 11513
  • FL License # OTA11513
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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