Provider Demographics
NPI:1093351876
Name:SHOTTS, KELLY (MS SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SHOTTS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP
Mailing Address - Street 1:412 GOTHAM RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2429
Mailing Address - Country:US
Mailing Address - Phone:757-615-2684
Mailing Address - Fax:
Practice Address - Street 1:412 GOTHAM RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2429
Practice Address - Country:US
Practice Address - Phone:757-615-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist