Provider Demographics
NPI:1083948079
Name:STAHL, KELLY ANN (MOT OTR)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:STAHL
Suffix:
Gender:F
Credentials:MOT OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9933 BEAM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9332
Mailing Address - Country:US
Mailing Address - Phone:317-796-4845
Mailing Address - Fax:
Practice Address - Street 1:9933 BEAM RIDGE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-9332
Practice Address - Country:US
Practice Address - Phone:317-796-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN257500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist