Provider Demographics
NPI:1164554408
Name:KELLY, CATHLEEN JOYCE (OTRL)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:JOYCE
Last Name:KELLY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-0035
Mailing Address - Country:US
Mailing Address - Phone:785-738-0321
Mailing Address - Fax:785-738-2028
Practice Address - Street 1:120 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420
Practice Address - Country:US
Practice Address - Phone:785-738-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01970225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist