Provider Demographics
NPI:1417949223
Name:LAYNE, KELLY A (OT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:LAYNE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:5501 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3850
Mailing Address - Country:US
Mailing Address - Phone:520-293-5551
Mailing Address - Fax:520-293-6638
Practice Address - Street 1:5501 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3829
Practice Address - Country:US
Practice Address - Phone:520-293-5551
Practice Address - Fax:520-293-6638
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86059251885705C021OtherTRICARE PROVIDER NUMBER
AZ86059251885705C021OtherTRICARE PROVIDER NUMBER