Provider Demographics
NPI:1063861656
Name:JONES, KELLY DUNN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DUNN
Last Name:JONES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 WATSONSEED FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHITAKERS
Mailing Address - State:NC
Mailing Address - Zip Code:27891-9141
Mailing Address - Country:US
Mailing Address - Phone:252-883-7975
Mailing Address - Fax:
Practice Address - Street 1:12625 WATSON SEED FARM RD
Practice Address - Street 2:
Practice Address - City:WHITAKERS
Practice Address - State:NC
Practice Address - Zip Code:27891
Practice Address - Country:US
Practice Address - Phone:252-883-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2090224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant