Provider Demographics
NPI:1205023322
Name:DEBOTH, KELLE KATHLEEN (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLE
Middle Name:KATHLEEN
Last Name:DEBOTH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8054 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2381
Mailing Address - Country:US
Mailing Address - Phone:330-963-8600
Mailing Address - Fax:
Practice Address - Street 1:8054 DARROW RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2381
Practice Address - Country:US
Practice Address - Phone:330-963-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.006316225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics