Provider Demographics
NPI:1356682363
Name:BLOOMFIELD, KELLI JANE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:JANE
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 COUNTRY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-9703
Mailing Address - Country:US
Mailing Address - Phone:501-208-1506
Mailing Address - Fax:
Practice Address - Street 1:209 COUNTRY VIEW CT
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-9703
Practice Address - Country:US
Practice Address - Phone:501-208-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2473225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics