Provider Demographics
NPI:1407998438
Name:PRIMM, KELLYANN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLYANN
Middle Name:MARIE
Last Name:PRIMM
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 1:719 THOMPSON LN STE 21000
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4689
Mailing Address - Country:US
Mailing Address - Phone:615-343-6445
Mailing Address - Fax:
Practice Address - Street 1:2200 CHILDREN'S WAY
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-4703
Practice Address - Country:US
Practice Address - Phone:615-936-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4713225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics