Provider Demographics
NPI:1225442965
Name:DOUGLAS, KELLI (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 STEWART DR APT 513
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-3145
Mailing Address - Country:US
Mailing Address - Phone:773-706-4012
Mailing Address - Fax:
Practice Address - Street 1:1864 HIGH GROVE LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9233
Practice Address - Country:US
Practice Address - Phone:708-478-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist