Provider Demographics
NPI:1225428204
Name:AULD-WRIGHT, KELLY DIANE (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DIANE
Last Name:AULD-WRIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 N VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2758
Mailing Address - Country:US
Mailing Address - Phone:909-870-8998
Mailing Address - Fax:
Practice Address - Street 1:1452 N VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2758
Practice Address - Country:US
Practice Address - Phone:909-870-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9637225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics