Provider Demographics
NPI:1396221875
Name:KUGEL, KELLY BASKIN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:BASKIN
Last Name:KUGEL
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 1:3080 JACKSON HWY UNIT F5
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-7701
Mailing Address - Country:US
Mailing Address - Phone:704-576-2187
Mailing Address - Fax:
Practice Address - Street 1:3080 JACKSON HWY UNIT F5
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-7701
Practice Address - Country:US
Practice Address - Phone:704-576-2187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60790430225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist