Provider Demographics
NPI:1477173946
Name:STIGGERS, KELLEY NICOLE (OTR)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:NICOLE
Last Name:STIGGERS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 ROSE CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76140-2096
Mailing Address - Country:US
Mailing Address - Phone:817-271-8867
Mailing Address - Fax:
Practice Address - Street 1:7513 ROSE CREST BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76140-2096
Practice Address - Country:US
Practice Address - Phone:817-271-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist