Provider Demographics
NPI:1356014658
Name:WELLIK, KACI (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:WELLIK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W SAINT JOHN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6583
Mailing Address - Country:US
Mailing Address - Phone:512-925-2099
Mailing Address - Fax:
Practice Address - Street 1:9821 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2344
Practice Address - Country:US
Practice Address - Phone:602-697-3457
Practice Address - Fax:480-777-2355
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist