Provider Demographics
NPI:1497248983
Name:JONES, KELLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:JONES
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 1:7102 ANN CABELL CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-5226
Mailing Address - Country:US
Mailing Address - Phone:804-401-0405
Mailing Address - Fax:317-884-3388
Practice Address - Street 1:1717 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3961
Practice Address - Country:US
Practice Address - Phone:804-401-0405
Practice Address - Fax:317-884-3388
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004439225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist