Provider Demographics
NPI:1578188223
Name:REYNOLDS, KELSEY ELAINE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELAINE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 5TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6651
Mailing Address - Country:US
Mailing Address - Phone:918-203-3313
Mailing Address - Fax:918-512-4082
Practice Address - Street 1:117 W 5TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6651
Practice Address - Country:US
Practice Address - Phone:918-203-3313
Practice Address - Fax:918-512-4082
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5234225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
405452OtherNBCOT
OK5234OtherOK MEDICAL BOARD