Provider Demographics
NPI:1407025232
Name:KELLEY, DONNA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:161 KLEVIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-561-8060
Mailing Address - Fax:907-563-3172
Practice Address - Street 1:161 KLEVIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-8060
Practice Address - Fax:907-563-3172
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
TX112240OtherHUMANA
TX112240OtherLICENSE #
TX111408402Medicaid