Provider Demographics
NPI:1154631109
Name:BARRON, KELLI (OT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BARRON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:608 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HAVEN
Mailing Address - State:KS
Mailing Address - Zip Code:67543-8009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 E 5TH ST
Practice Address - Street 2:
Practice Address - City:HAVEN
Practice Address - State:KS
Practice Address - Zip Code:67543-8009
Practice Address - Country:US
Practice Address - Phone:620-259-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03076225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist