Provider Demographics
NPI:1033378419
Name:NELSON, KELLI NICHOLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:NICHOLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:NICHOLE
Other - Last Name:CHRISTMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1105 SUSSEX COURT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-420-6307
Mailing Address - Fax:
Practice Address - Street 1:2225 OLD EMMORTON ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-515-4900
Practice Address - Fax:410-515-0777
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419800000Medicaid