Provider Demographics
NPI:1588822290
Name:OLMSTED, KELLI ANNE (MS OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANNE
Last Name:OLMSTED
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:ANNE
Other - Last Name:HEATON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS OTRL
Mailing Address - Street 1:302 ST CLOUD ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-343-4738
Mailing Address - Fax:605-343-8284
Practice Address - Street 1:302 ST CLOUD ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-343-4738
Practice Address - Fax:605-343-8284
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0613225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist