Basic Information
| Provider Information | |||||||||
| NPI: | 1689873838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLEHER | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085011618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092592161 | ||||||||
| FaxNumber: | 6096312862 | ||||||||
| Practice Location | |||||||||
| Address1: | 3575 QUAKERBRIDGE RD | ||||||||
| Address2: | CHILDREN'S SPECIALIZED HOSPITAL | ||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086191205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096312800 | ||||||||
| FaxNumber: | 6096312862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 46TR00322700 | NJ | Y | Other Service Providers | Specialist |
No ID Information.