Provider Demographics
NPI:1144618364
Name:WEHMEYER, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WEHMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W US HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:FLATONIA
Mailing Address - State:TX
Mailing Address - Zip Code:78941-5257
Mailing Address - Country:US
Mailing Address - Phone:979-966-2187
Mailing Address - Fax:
Practice Address - Street 1:1515 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:FLATONIA
Practice Address - State:TX
Practice Address - Zip Code:78941-5257
Practice Address - Country:US
Practice Address - Phone:979-966-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208995224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant