Provider Demographics
NPI:1497008791
Name:JOHNSON, KELLY ANN ELLEDGE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN ELLEDGE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONG SHOALS RD APT 4M
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7754
Mailing Address - Country:US
Mailing Address - Phone:618-977-0948
Mailing Address - Fax:
Practice Address - Street 1:9 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-0047
Practice Address - Country:US
Practice Address - Phone:828-944-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009900225X00000X
NC14276225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist