Provider Demographics
NPI:1114991759
Name:LUM, KELLY S (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:LUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4593
Mailing Address - Country:US
Mailing Address - Phone:540-886-5777
Mailing Address - Fax:540-886-5776
Practice Address - Street 1:102 BUSINESS WAY
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4593
Practice Address - Country:US
Practice Address - Phone:540-886-5777
Practice Address - Fax:540-886-5776
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist