Provider Demographics
NPI:1023395399
Name:KELL, JENNY (OTR)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:KELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:KELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 835613
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-5613
Mailing Address - Country:US
Mailing Address - Phone:214-679-3891
Mailing Address - Fax:469-405-2994
Practice Address - Street 1:16250 KNOLL TRAIL DR STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-2868
Practice Address - Country:US
Practice Address - Phone:214-679-3891
Practice Address - Fax:469-405-2994
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108852225XP0019X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation