Provider Demographics
NPI:1073050092
Name:OHDE, KELLI L (DPT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:L
Last Name:OHDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:L
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5100 PRAIRIE PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8155
Mailing Address - Country:US
Mailing Address - Phone:319-222-2901
Mailing Address - Fax:319-222-2991
Practice Address - Street 1:5100 PRAIRIE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8155
Practice Address - Country:US
Practice Address - Phone:319-222-2901
Practice Address - Fax:319-222-2991
Is Sole Proprietor?:No
Enumeration Date:2017-01-28
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0041462251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics