Provider Demographics
NPI:1235420860
Name:ENGELBY, KELLI S (COTA/L)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:S
Last Name:ENGELBY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4164 E WOODSIDE CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-3572
Mailing Address - Country:US
Mailing Address - Phone:330-321-1080
Mailing Address - Fax:
Practice Address - Street 1:4164 E WOODSIDE CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-3572
Practice Address - Country:US
Practice Address - Phone:330-321-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4806224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant